Dopamine Agonist ICD — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

EasyNeurologyDopamine Agonist ICDRACP Adult Medicine

A 62-year-old man with Parkinson's disease is commenced on pramipexole (a dopamine agonist). His wife reports he has developed compulsive gambling and hypersexuality, which is causing significant distress. What is this adverse effect called?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Obsessive-compulsive disorder

Dopamine agonists (pramipexole, ropinirole, rotigotine) are associated with impulse control disorders (ICDs) in up to 17% of patients. These include pathological gambling, hypersexuality, compulsive shopping, and binge eating. The mechanism involves overstimulation of mesolimbic D3 dopamine receptors. ICDs are more common with dopamine agonists than with levodopa. Management requires dose reduction or cessation of the dopamine agonist (with gradual taper to avoid dopamine agonist withdrawal syndrome – DAWS). Patients and families must be counselled about ICD risk BEFORE starting dopamine agonists.

Reference: AMH – 2025 – Dopamine Agonists; eTG – 2025 – Neurology; MDS – 2023