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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 I have a few patients who had the dopamine agonists withdrawn due to development of impulse control disorder (hyper-sexuality).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. 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