EULALEE THOMPSON
A small study of 11 United States patients have linked the use of Mirapex, a drug used to treat Parkinson's disease, to pathological gambling, hypersexuality and overeating but local patients are not having the same
side effects.
PARKINSON'S DISEASE patients taking the drug pramipexole, brand name Mirapex, appear to be displaying a very strange side effect - pathological gambling and other compulsive behaviours.
A U.S. study of 11 patients with Parkinson's disease, posted online but scheduled for publication in the September issue of the journal Archives of Neurology, indicates that the patients taking the dopamine agonist therapy pramipexole (Mirapex) became compulsive gamblers. Seven of the patients developed the compulsion within one to three months of reaching the maintenance dose or increasing the dosage. The other four patients showed features 12 to 30 months after starting the drug. Mayo Clinic (U.S.) researchers also report hypersexuality and overeating in patients on the drug.
Pramipexole was approved by the U.S. Food and Drug Administration in 1997 to treat symptoms of Parkinson's. The symptoms, which include tremors and stiffness, are related to a deficiency in a brain chemical, dopamine. Pramipexole is believed to act by stimulating dopamine receptors.
According to webmd.com, the drug levodopa for many years was the preferred drug to treat Parkinson's but its long-term use is linked to motor complications. Many doctors now use the newer dopamine agonists (such as pramipexole and ropinirole) in the early stages of Parkinson's.
The drug is not yet locally available but Dr. John Hall, consultant neurologist and president of the Medical Association of Jamaica (MAJ), says that a number of his patients with Parkinson's have been able to access the drug abroad and have been using it.
SOCIO-ECONOMIC DIFFERENCES
"Those side effects have not come to light here, by that I mean that I have not been noticing hypersexuality, overeating, compulsive gambling in my patients," he said.
Some of the differences in side effects between the U.S. and Jamaican patients, he said, may be rooted in socio-economic conditions.
"Perhaps the U.S. patients are from an income group where they have trust funds and other sources of disposable incomes to engage in compulsive gambling and other behaviours ... but a little poor man, a cultivator in Jamaica, would not have the income to engage in that kind of compulsive behaviour," Dr. Hall said.
He also indicated that it could be that the drug is not being used here long enough to show up these side effects, and that there could also be a difference in racial response.
"There is actual racial differences in therapeutics ... because we are finding that even in the cases of drugs used to treat hypertension that there is a difference in response between black and white people," Dr. Hall said.
He also questioned the sample size of the study.
"I think the study is much too small to make dogmatic statements on side effects...it may just be indicating trends. In my experience, I must say that I have reason to commend the drug's efficacy," Dr. Hall said.
You can send your comments to eulalee.thompson@gleanerjm.com.
