Makindo Medical Notes

Important: Impulse control disorders (ICDs) can develop in a person with Parkinson’s disease who is on any dopaminergic therapy at any stage in the disease course.

About

• Impulse control disorders are a known side effect in patients with Parkinson’s disease, especially those treated with dopamine agonists. However, they can also occur with other dopaminergic medications (such as levodopa).

Clinical Presentation

• Behaviors may include: Gambling, Hypersexuality, Compulsive shopping, Excessive eating or binge behaviors
• Punding — an intense fascination with (and repetitive handling of) objects. Examples: repeatedly disassembling and reassembling household devices (e.g., radios), obsessive rearranging of items, or repetitive skin picking.

Common Causative Medications (with Typical Dose Ranges)

• Levodopa/Benserazide (Madopar)
  • Typical daily dose (as levodopa) can range from 300 mg to 800 mg in divided doses.
  • Initiated at a low dose (e.g., 50–100 mg levodopa three times daily) and titrated gradually.
• Levodopa/Carbidopa (Sinemet)
  • Typical daily dose (as levodopa) can range from 300 mg to 1,000 mg in divided doses.
  • Common starting regimen might be 100/25 mg (levodopa/carbidopa) three times daily, increasing as tolerated.
• Dopamine Agonists
  • Pramipexole:
    • Common starting dose: 0.125–0.25 mg three times daily.
    • May be titrated up to 1.5 mg three times daily, depending on formulation and tolerance.
  • Ropinirole:
    • Common starting dose: 0.25 mg three times daily.
    • Titrated up to 8 mg three times daily (or more), depending on clinical response and side effects.
  • Rotigotine patch:
    • Initial dose commonly 2 mg/24 hr, can be increased up to 8 mg/24 hr or higher.

Management of Impulse Control Disorders

• Medication Adjustment:
  • Gradually reduce or discontinue the implicated dopaminergic drug (especially dopamine agonists) until ICD symptoms improve.
  • Reassess the entire Parkinson’s medication regimen to balance motor symptom control with minimizing ICD risks.
• Non-pharmacological Support:
  • Behavioral or cognitive-behavioral therapy to address compulsive or impulsive behaviors.
  • Lifestyle modifications, psychosocial interventions, and close monitoring for early signs of relapse.