Mirapex / Requip / Neupro: Significant Increased Risk Of Compulsive Behaviors -- Gambling, Shopping, And Sex -- For These Parkinson's And Restless Leg Drugs

When reading this report by Tom Lamb, please bear in mind that less than 10% of adverse drug events are ever recorded on official databases and come sceptical experts think the actual figure is less than 1%.  My main concern with these drugs is their use for treating restless legs.  Drugs such as these are not treating the root causes - merely suppressing symptoms while placing the patient at risk of a long list of nasty side effects - such as risking becoming a compulsive sex pervert or gambling away the family home!
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These Impulse Side Effects, As Seen In Adverse Drug Events Reports, Are Much Higher Than Previously Thought According To New Medical Journal Article

(Posted by Tom Lamb at DrugInjuryWatch.com) 
Thomas Moore, A.B., a senior scientist at the Institute of Safe Medication Practices (ISMP), together with his fellow authors of a new medical journal article are calling for the addition of a so-called "black-box" warning to the drug labels for Mirapex, Requip, Neupro, and other medications used for Parkinson's disease and restless leg syndrome. 

Based on their findings about impulse control problems associated with these "dopamine agonists" drugs, they think there should be a heightened warning about unusual side effects in the form of compulsive behaviors involving gambling, shopping, and sex.

This new medical journal article is "Reports of Pathological Gambling, Hypersexuality, and Compulsive Shopping Associated With Dopamine Receptor Agonist Drugs", which was published online October 20, 2014 by the medical journalJAMA Internal Medicine.

From an October 21, 2014 news report by HealthDay, "Parkinson's Drugs May Spur Compulsive Behaviors", we get this commentary and insight:

Drugs commonly used to treat Parkinson's disease may raise the risk of so-called impulse control disorders, according to a new review.

These disorders include compulsive gambling, compulsive shopping and/or hypersexuality.

That increased risk was seen in a fresh review of a decade's worth of U.S. Food and Drug Administration (FDA) records....

The study's authors stressed that these medicines are widely used to treat a range of illnesses, including Parkinson's, restless leg syndrome and patients diagnosed with high levels of the hormone prolactin -- which can cause impotence in men and can prevent pregnancy in women.

More than 2 million such prescriptions were filled during the last three months of 2012 alone, the researchers noted....

Nearly 45 percent of [710 "serious" impulse control adverse drug events reports made to FDA] were linked directly to the use of any of six different dopamine receptor agonist medications, with most involving male patients (more than 65 percent) at an average age of 55. The other 55 percent of cases were associated with the use of other medications, the study found.

More than 60 percent of the time, the impulse control cases involving dopamine receptor agonists were patients struggling with Parkinson's, while nearly a quarter involved patients with restless leg syndrome, the researchers said.

Breaking it down, the team identified 628 instances of pathological gambling, 465 cases of hypersexuality, and 202 examples of compulsive shopping.

"I should say that the risk for these events does not appear to be rare at all," said Moore. "These psychiatric side effects appear to occurring among at least 10 percent of patients. If you compare that with, say, the risk for suicide among patients who take antidepressant drugs, this is much higher. It's an astronomical rate, in terms of drug adverse event risk. And frankly I think I'm being conservative."

In fact, some patients have sued the manufacturer of Mirapex, Boehringer Ingelheim, alleging that this Parkinson's disease drug triggered their pathological gambling which resulted in significant economic damages and other losses.

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Restless Legs - Or, more affectionately what is known as the "Wiggles"

While touring Australia, co-presenting a course for health professionals about burnout in athletes, I have been bothered at night by my worst run ever of Restless Legs.  The reason for the upsurge is obvious to me: Physical and mental exhaustion, combined with poor circulation.

In addition to being on my feet most of the day in the front of a highly knowledgeable audience (stress!), I am also spending a good deal of time hanging around airports and then sitting cramped up for hours in aircraft (poor circulation), which means:  Poor oxygenation of the legs and poor elimination of metabolic by-products which can lead to cramp.

Restless Legs Syndrome (RLS) is an uncontrollable urge to move the legs, or creepy-crawly sensations in the legs that often leads to sleep deprivation.  It is a most unpleasant sensation that can literally drive the afflicted person crazy - or the person trying to sleep next to you while you squirm and wriggle away.  A light-hearted description of the ailment is the "Wiggles".

There is no denying that there are many people who suffer from leg pain and irritation while in bed; but this does not mean that the only therapy is to take a costly, powerful drug that come with a long list of nasty side effects.

The Wiggles is usually experienced at night, when in bed, and most intense during the first few hours of turning in.  It can affect both the very unfit and the very fit equally but may be exacerbated by fatigue.

Here's what I think is going on:  During sleep the body's central metabolism slows.  What this means is the heart slows, the blood pressure drops, as does body temperature.  The problem is that some muscles may still be right smack in the middle of working hard to replenish depleted nutrient stores and flush out metabolic toxins following a hard day.  The muscles most likely to be afflicted are those of the lower legs because they tend to be most stressed during an exhausting day and, being furthest from the heart, are most likely to suffer the most from anything related to a reduction in circulation.

Circulation in the limbs is also partially dependent on regular muscle contraction which squeezes dirty blood back to the heart, lungs and liver.  When the muscles are relaxed and still, blood flow is dependent on good blood pressure and a strong pulse which decline during sleep.

This explains why the Wiggles is experienced mostly during bed rest and most often after an exhausting day.

To explain more about why it may be experienced more after a tiring day, be it a walk in the bush or long day in front of an audience:  If there is already poor circulation in the legs, such as comes with ageing and/or if the person is exhausted from something like a long day on their feet, then there is a buildup of metabolic toxins and a reduction of oxygen in the tissues.  This may build to a critical level, causing micro cramping in the muscles of the lower legs and the feet during the early hours of sleep.  This is felt as a crawling sensation in the legs and an uncontrollable urge to flex and extend the legs.  This is most unpleasant and sleep is completely disturbed.

That this unpleasant sensation is relieved by movement is a clue to its cause and to its relief.

Rather than resort to medication, try these first:

Avoid a hot bath before bed and sleep in a cool room and cool bed
If you are hot and sweaty in bed, precious blood flow will be diverted to the skin away from the muscles.  You may find a cold shower before bed may be beneficial.  The vasoconstriction in the skin will divert blood to the deep muscles.

If you get the Wiggles, get your legs dancing
Turn on your bedside radio and tune into some easy listening music.  In rhythm to the music while still lying flat, gently flex and extend your ankles in time with the beat.


At the end of the 3-5 minute track, get out of bed and walk the length of the house (just a minute or two), then get back into bed.

Repeat another track of music, paddling with the feet, then go for another leisurely walk.


Then paddle another track of music while lying in bed.  By about this time, you should feel a relieving of the tightness and cramping in the legs.  You might want to do another one or two slow tracks of music without getting up and walking.....

Hopefully, you (and your very, very understanding partner) will nod off during one of these tracks and you will have a good night's sleep.

Why it works
Rhythmic flexing of the legs activates the muscle pump of the lower legs, by which the steady contracting and relaxing of of the calf muscles pumps the stagnant venous blood back to the heart, creating space in the legs and feet for their infusion with fresh, oxygenated arterial blood.  Any discomfort should disappear entirely as you rhythmically cycle through the music tracks and the backlog of stagnant blood is finally flushed out.

This method gets to the heart of the cause - metabolic stress in the legs.

Other valuable measures include:

• Reviewing medication such as antidepressants, cholesterol and blood pressure pills which may be direct or indirect causes of the Wiggles.
• Ensuring that the diet is rich in nutrients and antioxidants which assist circulation, muscle relaxation and protect against oxidative stress.
• Avoid tea, coffee, chocolate, red wine and spicy foods from late afternoon to evening.
• Moderate your exercise and try to get off your feet towards the end of the day.  It is better to exercise vigorously early in the day and restrict evening exercise to activities like Yoga.
• Go for a walk in the cool of the evening and do some yoga-style stretching before bed and try a cold shower.

I know, I know!  The problem with these brilliant solutions, if you are like me, is once in bed total apathy sets in.  Rather than do anything beneficial, you will just lie there and wiggle in agony and drive your partner nuts!  That's me to a "T"!

If you try this method for managing the Wiggles, please tell us how you get on by writing a letter to the Editor.

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