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PD – Dopamine Agonist Sleepiness and Driving — SCE Neurology MCQ

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ModerateMovement DisordersPD – Dopamine Agonist Sleepiness and DrivingSCE Neurology

A 50-year-old man with Parkinson's disease has been on pramipexole for 4 years. His wife reports he has become increasingly somnolent during the day, occasionally falling asleep without warning, including while driving. What is the most critical immediate advice?

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Correct answer: E — He must stop driving immediately and report to the DVLA

Dopamine agonists (pramipexole, ropinirole) are associated with sudden onset sleep and excessive daytime somnolence. NICE NG71 and DVLA guidance mandate that anyone experiencing sudden onset sleep or excessive sleepiness must stop driving immediately and notify the DVLA. Driving must not resume until the symptoms are controlled. The dopamine agonist should be reduced or stopped. A: Caffeine is insufficient for pathological somnolence. C: Dose reduction should be recommended, not contingent on agreement. D: Ropinirole has similar risks. E: Modafinil may be considered but the immediate priority is driving cessation.

Reference: NICE NG71 Parkinson's Disease (2017); DVLA – Assessing Fitness to Drive (2025)