A 62-year-old man presents with resting tremor, rigidity, bradykinesia, and postural instability for 3 years. He now develops impulse control disorders (hypersexuality, compulsive gambling) after starting a new medication. Which recently started drug is most likely responsible?
- A Levodopa-carbidopa
- B Ropinirole (dopamine agonist) ✓
- C Selegiline (MAO-B inhibitor)
- D Amantadine
Explanation
Impulse control disorders (ICDs) — including pathological gambling, hypersexuality, compulsive eating, and compulsive shopping — are a well-recognised class effect of dopamine receptor agonists (pramipexole, ropinirole, cabergoline) in Parkinson's disease, occurring in up to 13–17% of patients. They result from agonist activity at mesolimbic D3 receptors. Levodopa at standard doses carries a much lower risk of ICDs. Selegiline (MAO-B inhibitor) has dopaminergic augmentation but is not the primary culprit. Amantadine is used to treat dyskinesias and does not cause ICDs.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.