It is a very good article. The withdrawal symptoms are probably uncommon. I have a few patients who had the dopamine agonists withdrawn due to development of impulse control disorder (hyper-sexuality). They did not have the withdrawal symptoms as described in this report.

 

But the withdrawal symptoms should be looked out for - dopamine certainly affects the mood and behaviour.

 

NK Chew
 
> Date: Tue, 12 Jan 2010 11:05:07 +0200
> From: [log in to unmask]
> Subject: Re: reducing agonists
> To: [log in to unmask]
> 
> Another reason to avoid them as long as possible...
> 
> Nic 57/16
> 
> 2010/1/12 mschild <[log in to unmask]>
> 
> > Reducing Dosage of Parkinson's Drugs Can Cause Symptoms Similar to Those of
> > Cocaine Withdrawal
> > ScienceDaily (Jan. 11, 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. Led by a physician-scientist
> > at
> > NewYork-Presbyterian Hospital/Weill Cornell Medical Center, the study is
> > reported in the Jan. 11 Archives of Neurology.
> > "Like cocaine and methamphetamines, dopamine agonists work by stimulating
> > the
> > reward pathways in the brain. For this reason, it makes sense that they
> > would
> > engender similar withdrawal symptoms, particularly in those with high
> > cumulative drug exposure," says senior author Dr. Melissa J. Nirenberg,
> > associate director of the Parkinson's Disease and Movement Disorders
> > Institute
> > at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and assistant
> > professor of neurology and neuroscience at Weill Cornell Medical College.
> > Dopamine agonists are highly effective drugs that are prescribed to many
> > Parkinson's patients to avoid side effects of the "gold standard" drug
> > L-DOPA,
> > particularly abnormal involuntary movements referred to as dyskinesias. (L-
> > DOPA was perfected by Dr. George C. Cotzias of Cornell University Medical
> > College in the late 1960s; dopamine agonists have been available since the
> > 1990s.) DAs are also FDA-approved for treatment of restless legs syndrome,
> > and
> > used off-label for other conditions such as depression and fibromyalgia. In
> > the
> > United States, there are currently two DAs on the market -- pramipexole
> > (Mirapex®) and ropinirole (Requip®, Requip XL®).
> > In recent years, there have been increasing concerns about DA side effects,
> > and
> > particularly the fact that they can cause uncontrolled, compulsive
> > behaviors
> > known as impulse control disorders (ICDs). ICDs are reported to occur in
> > about
> > 14 percent to 17 percent of PD patients who use these drugs, and also occur
> > in
> > people who use DAs to treat other medical conditions. In 2006, Dr.
> > Nirenberg
> > published research linking the use of DAs to compulsive eating; others have
> > linked the drugs to behaviors such as compulsive gambling, buying,
> > hypersexuality and Internet addiction. Patients are often unaware of these
> > addictive behaviors, or may not discuss them with physicians because they
> > are
> > in denial, embarrassed by their symptoms, or unaware that they are a
> > medication side effect.
> > "Impulse control disorders stemming from use of dopamine agonists can be
> > detrimental to a patient's financial, social and physical well-being. 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," says Dr.
> > Nirenberg.
> > Study Design and Findings
> > In the current study, Dr. Nirenberg and first author Christina A. Rabinak,
> > a
> > third-year medical student at Weill Cornell Medical College, 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, five patients
> > (19
> > percent) experienced DAWS. Two of the subjects with DAWS recovered fully,
> > but
> > three of the five 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 only occurred in patients with ICDs, and not in those who tapered DAs
> > for
> > other reasons. However, only one-third of patients with ICDs experienced
> > DAWS.
> > Withdrawal symptoms were only alleviated by increasing the DA dosage. Other
> > treatments, including high doses of L-DOPA, antidepressants, tranquilizers
> > and
> > psychotherapy, were ineffective.
> > DAWS correlated with cumulative exposure to DAs, with the most severe
> > symptoms
> > occurring in patients with the greatest DA exposure.
> > Subjects with DAWS had milder physical disability than those without.
> > The Message for Patients & Physicians
> > "DAWS has been difficult to identify because its symptoms are 'invisible'
> > --
> > mainly psychological in nature," says 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
> > L-
> > DOPA.
> > Dr. Nirenberg recommends that patients "educate themselves about DA side
> > effects, involve family members and friends in monitoring their behavior
> > for
> > possible ICDs, and promptly inform their physicians if they experience ICDs
> > or
> > DAWS." The authors also 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. As for future directions, Dr. Nirenberg
> > stated
> > "the most important unanswered questions are how to reduce the risk of
> > DAWS,
> > and how to treat DAWS once it occurs."
> > The current study was supported by the Parkinson's Disease Foundation.
> >
> > ----------------------------------------------------------------------
> > To sign-off Parkinsn send a message to: mailto:
> > [log in to unmask]
> > In the body of the message put: signoff parkinsn
> >
> 
> ----------------------------------------------------------------------
> To sign-off Parkinsn send a message to: mailto:[log in to unmask]
> In the body of the message put: signoff parkinsn
 		 	   		  
_________________________________________________________________
New Windows 7: Simplify what you do everyday. Find the right PC for you.
http://windows.microsoft.com/shop
----------------------------------------------------------------------
To sign-off Parkinsn send a message to: mailto:[log in to unmask]
In the body of the message put: signoff parkinsn