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Dopamine agonist withdrawal syndrome: implications for patient care.

Identifier

013025

Type of Spiritual Experience

Hallucination

Number of hallucinations: 1

Background

Dopamine agonists are used to treat Parkinson's disease, attention deficit/hyperactivity disorder and certain pituitary tumors (prolactinoma),  restless legs syndrome (RLS).

There is even an ongoing clinical trial to test the effectiveness of the dopamine agonist Requip (ropinirole) in reversing the symptoms of SSRI-induced sexual dysfunction and Post-SSRI sexual dysfunction (PSSD).

They are also being recommended for  'ovarian hyperstimulation syndrome' (OHSS), in women undergoing stimulated cycles of in vitro fertilization (IVF)

A description of the experience

Drugs Aging. 2013 Aug;30(8):587-92. doi: 10.1007/s40266-013-0090-z.

Dopamine agonist withdrawal syndrome: implications for patient care.

Nirenberg MJ.  Department of Neurology, NYU School of Medicine, New York, NY, USA. melissa.nirenberg@nyumc.org

Abstract

Dopamine agonists are used as treatments for a variety of indications, including Parkinson's disease and restless legs syndrome, but may have serious side effects, such as orthostatic hypotension, hallucinations, and impulse control disorders (including pathological gambling, compulsive eating, compulsive shopping/buying, and hypersexuality).

The most effective way to alleviate these side effects is to taper or discontinue dopamine agonist therapy.

A subset of patients who taper a dopamine agonist, however, develop dopamine agonist withdrawal syndrome (DAWS), which has been defined as a severe, stereotyped cluster of physical and psychological symptoms that correlate with dopamine agonist withdrawal in a dose-dependent manner, cause clinically significant distress or social/occupational dysfunction, are refractory to levodopa and other dopaminergic medications, and cannot be accounted for by other clinical factors.

The symptoms of DAWS include anxiety, panic attacks, dysphoria, depression, agitation, irritability, suicidal ideation, fatigue, orthostatic hypotension, nausea, vomiting, diaphoresis, generalized pain, and drug cravings.

The severity and prognosis of DAWS is highly variable. While some patients have transient symptoms and make a full recovery, others have a protracted withdrawal syndrome lasting for months to years, and therefore may be unwilling or unable to discontinue DA therapy.

Impulse control disorders appear to be a major risk factor for DAWS, and are present in virtually all affected patients. Thus, patients who are unable to discontinue dopamine agonist therapy may experience chronic impulse control disorders.

At the current time, there are no known effective treatments for DAWS. For this reason, providers are urged to use dopamine agonists judiciously, warn patients about the risks of DAWS prior to the initiation of dopamine agonist therapy, and follow patients closely for withdrawal symptoms during dopamine agonist taper.

PMID:  23686524

The source of the experience

PubMed

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References