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| |  Researchers Identify, Define Dopamine Agonist Withdrawal Syndrome NEW YORK -- January 12, 2010 -- New research has shown that reducing the dosage of dopamine agonist (DA) drugs, a mainstay treatment for Parkinson’s disease (PD), sometimes causes acute withdrawal symptoms similar to those reported by cocaine addicts -- including anxiety, panic attacks, depression, sweating, nausea, generalized pain, fatigue, dizziness and drug cravings. These symptoms can be severe, and are not alleviated by other PD medications. For the first time, researchers have defined this phenomenon, which they call dopamine agonist withdrawal syndrome, or DAWS. The study is reported in the January 11 Archives of Neurology. “Like cocaine and methamphetamines, dopamine agonists work by stimulating the reward pathways in the brain,” said senior author Melissa J. Nirenberg, MD, Parkinson’s Disease and Movement Disorders Institute at the NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York. “For this reason, it makes sense that they would engender similar withdrawal symptoms, particularly in those with high cumulative drug exposure.” In recent years, there have been increasing concerns about DA side effects, and particularly the fact that they can cause uncontrolled, compulsive behaviorus known as impulse control disorders (ICDs), which are reported to occur in about 14% to 17% of PD patients who use these drugs, and also occur in people who use DAs to treat other medical conditions. “Impulse control disorders stemming from use of dopamine agonists can be detrimental to a patient’s financial, social, and physical well-being,” said Dr. Nirenberg. “Our research identifies another concern -- namely that some patients experience severe, even intolerable, withdrawal syndromes when their dosage is reduced. In this context, it’s very important that physicians and their patients use DAs judiciously, and exercise caution when they are tapered.” In the current study, Dr. Nirenberg and colleagues performed a retrospective analysis of a cohort of 93 people with Parkinson’s disease, of whom 40 received DAs, and 26 tapered a DA for any of a variety of reasons -- most commonly because of ICDs. Among those who tapered a DA, 5 patients (19%) experienced DAWS. Two of the subjects with DAWS recovered fully, but 3 of the 5 were unable to successfully discontinue the drug because of severe withdrawal symptoms. These three study participants are currently living with their ICDs. The NewYork-Presbyterian/Weill Cornell researchers made several observations about DAWS: “DAWS has been difficult to identify because its symptoms are ‘invisible’ -- mainly psychological in nature,” said Dr. Nirenberg. In fact, both patients and physicians have mistaken DAWS for a mental health condition such as anxiety or depression. DAWS has also been misinterpreted as a manifestation of PD itself, or of wearing off between doses of medication -- something disproven by the fact that the symptoms are not alleviated by even very high doses of levodopa. The authors provide specific advice for clinicians who use DAs: (1) avoid prescribing high doses of DAs, (2) closely monitor DA-treated patients for signs of ICDs, (3) warn patients of the risks of DAWS, (4) taper DAs at the first sign of ICDs, and (5) closely monitor patients when tapering DAs, particularly those with ICDs. SOURCE: NewYork-Presbyterian Hospital/Weill Cornell Medical Center
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