Yourlawyer.com (Mirapex News)

Mirapex, Other Parkinson's Disease Drugs Linked Compulsive Gambling, Hypersexuality

Tue, 14 Apr 2009 00:00:00 -0700

Mirapex and other dopamine agonists used to treat Parkinson's Disease have been linked to the development of extreme behaviors by yet another study. According to researchers at the Mayo Clinic, one in five patients taking such drugs in a recent study developed behavior disorders, such as compulsive gambling or hypersexuality.

Dopamine agonists like Mirapex have long been suspected of causing compulsive behavior. The suspicion was bolstered last June, when researchers investigating the link between dopamine agonists and compulsive behavior presented their findings at International Congress of Parkinson’s Disease and Movement Disorders conference in Chicago. The study, which looked at more than 3,000 patients from 46 medical centers in the United States and Canada, found that Parkinson’s patients on dopamine agonists are nearly three times more likely to have at least one impulse-control disorder - including gambling addiction - compared with patients receiving other treatments.

Parkinson's Disease occurs because of a lack of the neurotransmitter dopamine in certain areas of the brain. A dopamine agonist works by mimicking the effects of this chemical. However, dopamine is also known to produce a “rush” in the brain of people who are anticipating a reward or excitement. Many experts believe that such a biochemical reaction is behind the reports of compulsive behavior linked to dopamine agonists like Mirapex.

The Mayo Clinic study involved 267 patients treated between 2004 and 2006 in a seven-county area around the Mayo clinic. Sixty-six were taking a dopamine agonist at a therapeutic level, but only 38 were using doses in the therapeutic range, 178 were taking carbidopa/levodopa without a dopamine agonist, and 23 were untreated.

Six of the patients taking dopamine agonists developed a behavioral disorder (an occurrence rate of 18.4 percent for this group). Five developed a gambling addiction and five became hypersexual (both disorders developed in three of the patients). Other compulsive behaviors were noted as well. Though in some cases the behaviors continued for years, the Mayo Clinic researchers found that they abated when the patients stopped dopamine agonist therapy.

None of these behaviors were seen in untreated patients, those taking less than a therapeutic dose of a dopamine agonist, or patients receiving treatment with carbidopa/levodopa alone, the researchers said.

The researchers advised that the severity of the problems seen indicated that patients and doctors needed to be more aware of the behavioral side effects associated with dopamine agonists. In at least 2 cases, patients were subjected to intense psychiatric treatment before dopamine agonists were recognized as a likely cause of their disorder.

"Physicians treating Parkinson's Disease with dopamine agonists should obviously warn the patients, spouses, and families of such risks because they may not recognize the relationship to the drug until disastrous consequences have occurred," the study authors said.

Mirapex Victim Awarded $8.2 Million in First Gambling Addiction Lawsuit

Sat, 02 Aug 2008 00:00:00 -0700

The first Mirapex lawsuit to go to trail has resulted in an $8.2 million award to the plaintiff, Mealey's Emerging Drugs & Devices is reporting. The lawsuit was the first of more than 300 to go to trail in the Mirapex multidistrict litigation in the US District Court in Minneapolis that blame the Parkinson's Disease drug for causing compulsive gambling. It was considered a bellweather case, and was being watched by many to gauge the strengths and weaknesses of the other Mirapex lawsuits.

Gary Charbonneau, who began taking Mirapex in December 1997, said he suffered from a gambling addiction from March 2002 to February 2006. In that period of time, he gambled away $260,000. Charbonneau's lawsuit not only claimed that Mirapex caused his gambling problem, but that the drug's makers, Pfizer and Boehringer Ingelheim, knew about its potential to cause compulsive behavior, but did not issue any warnings, or take steps to investigate the true scope of the problem.

Other Mirapex lawsuits claim that Boehringer Ingelheim received reports linking the drug to compulsive behavior during clinical trials conducted in the 1990s, and received additional reports of patients developing gambling addictions after it came on the market. It wasn't until 2005 - eight years after its introduction - that information about compulsive behavior was finally added to the Mirapex label.

The defendants argued that they were not liable for Charbonneau's addiction because the Food & Drug Administration (FDA) had not asked for any label changes, despite reports that Mirapex was causing compulsive behavior. They also argued that Charbonneau's gambling problem started years after he began treatment with Mirapex, and continued long after he stopped taking the drug.

The federal jury, however, agreed with Charbonneau and awarded him all of his gambling losses, along with $7.8 million in punitive damages. Neither Pfizer nor Boehringer Ingelheim have commented on Thursday's verdict, but an appeal is likely.

Mirapex, one of a class of drugs known as dopamine agonists, has long been suspected of causing compulsive behavior. The suspicion was bolstered in June, when researchers investigating the link between dopamine agonists and compulsive behavior presented their findings at International Congress of Parkinson’s Disease and Movement Disorders conference in Chicago. The study, which looked at more than 3,000 patients from 46 medical centers in the United States and Canada, found that Parkinson’s patients on dopamine agonists are nearly three times more likely to have at least one impulse-control disorder - including gambling addiction - compared with patients receiving other treatments.

As Mirapex Lawsuits Commence, More Evidence Links Parkinson's Drug to Gambling Addiction, Other Compulsive Behavior

Tue, 29 Jul 2008 00:00:00 -0700

For many patients with Parkinson's Disease, the drug Mirapex seemed to be a miracle. It offered the promise of stopping the tremors many had experienced or decades. Unfortunately, it is now apparent that Mirapex and similar drugs cause bizarre behavior in some users - with some developing gambling problems, heightened sexual interest or compulsive spending and eating habits where there had previously been no sign of compulsive behavior.

This week, the first of three "bellweather" trials concerning Mirapex and its alleged linkage to compulsive gambling is underway in U.S. District Court in Minneapolis. More than 200 people are suing Boehringer Ingelheim Pharmaceuticals, the maker of Mirapex, over compulsive behavior they say it caused.   These first three trials will be used by many legal experts to gauge the strengths and weaknesses of those cases.

People with Parkinson's lack dopamine in key areas of the brain.   Mirapex and drugs like it are known as a dopamine agonist, and they work by mimicking the effects of this vital hormone and neurotransmitter. Other dopamine agonists include Requip, Parlodel, Dostinex Apokyn and Neupro.

For years, people taking Mirapex and similar drugs have complained about problems with compulsive behavior. Most of those complaints involved people who had no history of compulsive behavior before they started dopamine agonist therapy, and most reported that the behavior stopped as soon as they quit using the drugs. Several small studies, including one published in 2005 by Mayo Clinic researchers, found a link between the drugs and compulsive behavior, especially gambling addiction.   The drugs' labeling also includes warnings about possible compulsive behavior.

In June, results from the largest study ever to investigate the connection between compulsive behavior and dopamine agonists was presented at the at the International Congress of Parkinson's Disease and Movement Disorders conference in Chicago. That study found that more than 13 percent of patients taking dopamine agonists, sold under brand names suffer from at least one of four serious behavioral addictions.

The study, which looked at more than 3,000 patients from 46 medical centers in the United States and Canada, found that Parkinson's patients on dopamine agonists are nearly three times more likely to have at least one impulse-control disorder compared with patients receiving other treatments.

The growing evidence that Mirapex and other similar drugs are linked to compulsive behavior has changed the way some doctors approach these medications. Dr. Eric Ahlskog, a neurologist at the Mayo Clinic who has treated Parkinson's patients for 25 years, told The Chicago Tribune that he no longer is comfortable starting patients on dopamine agonists after three patients in his practice last year developed significant gambling and sexual problems.

Other doctors told the Tribune that while they still treat patients with dopamine agonists, they are using smaller doses. Many are also now asking the patients they treat with the drugs and their families about compulsive behaviors as part of routine patient checkups.

Man Sues Claiming Mirapex Caused Compulsive Gambling

Thu, 10 Jul 2008 00:00:00 -0700

Randolph Simens, a 55-year-old former and successful Wall Street banker said he has lost millions of dollars due to a compulsive gambling habit prompted and caused by Mirapex, a popular drug used to treat Parkinson's disease and restless leg syndrome. Simens is suing all the companies involved with the drug for his losses—which total $3 million—including German drug maker Boehringer Ingelheim, Pfizer, and Pharmacia & Upjohn.

Simens’ lawsuit alleges that Mirapex made him into a "pathological" gambler and that his addiction "ruined me," the New York Daily News quotes. "I became like a robot." The lawsuit was filed in New York State Court on Tuesday and accuses the privately held drug maker of breach of warranty, negligence, and negligent misrepresentation. Simens said he took Mirapex, from 2002 to 2007 following his diagnoses with Parkinson's disease and also after suffering hand tremors. "It put a little tickle in me and then snowballed within a month," said Simens, who filed the lawsuit on his own because he said he cannot afford a lawyer. The defendants "had a duty to provide adequate warnings and instruction for Mirapex, to use reasonable care to design a product that is not reasonably dangerous to users, and to adequately test their product," the lawsuit said.

Simens is not the first gambling addict to sue Boehringer Ingelheim; however, Boehringer Ingelheim adamantly denies any scientific evidence proving a link between Mirapex and gambling addictions. A spokesperson for Pfizer said the company had not marketed Mirapex since 2005 when medical studies first linked Mirapex to compulsive behaviors, including compulsive gambling. Pfizer said it "acted reasonably and appropriately during the entire time period it was involved with Mirapex." Mirapex is still sold in the United States market and is also prescribed for restless leg syndrome. Boehringer Ingelheim updated Mirapex's label in 2005 to include reports of "compulsive behavior" among Mirapex patients.

Simens said he was a recreational gambler before being prescribed Mirapex, but that he quickly became reckless, spending entire nights gambling over the Internet and traveling to casinos. "It's stupidity. I just couldn't stop," he said. When he read an article that suggested a link between Mirapex and compulsive behaviors, including gambling, he said he felt a wave of relief. Simens said he has joined a gambler's support group and, within five weeks of stopping Mirapex, stopped gambling.

The lawsuit claims Boehringer Ingelheim should have done more to warn patients of the potential for compulsive gambling. According to the suit, Simens—a father of two—began taking Mirapex in 2002 but didn't learn about the label change until 2006, when he read about a film director who blamed a gambling binge on Mirapex. At that point he claims to have been already out of control, running through his children’s bank accounts.

A recent Canadian and American study found that people taking dopamine agonist drugs—Mirapex is in this class of drugs—which help control movement problems, were two-to-three times more likely to have at least one of four common impulse control disorders: Pathological gambling, compulsive buying, compulsive sexual behavior, and binge eating.

A Popular Prescription Connected to Compulsive Behavior

Thu, 13 Jul 2006 00:00:00 -0700

A local man blames his medication for gambling away $500,000 and losing his family.

“I just felt like I was in a fast car all the time just trying to get somewhere and I didn't really have no place to be," said Jackie Mills.

Mills, 41, is a veteran of two wars. As a Marine, he fought for his country in the Persian Gulf. Six years ago, he waged a war with a debilitating disease.

"I had loss of my right arm. I had difficulty standing for long hours. I'd get dizzy. I was always sleepy," said Mills.

The car salesman, husband and father of two was diagnosed with Parkinson’s Disease at just 35.

But doctors told him there was hope in a new drug called Mirapex.

"The doctors at the VA recommended that I use Mirapex because it was a new and updated drug and it was more for my age," said Mills.

In the beginning, Mills says he took Mirapex as prescribed by his doctor, a half milligram every two hours. His dizziness stopped. His tremors became less obvious. The disease was manageable.

"I said, 'hey this is what I need.' It gets me out there, it gets me going everyday," said Mills.

For the first 18 months, Mirapex had allowed him to live an near, normal life. But in 2002, there was a problem.

"I couldn't do things in moderation, everything had to be all the time," said Mills.

Mills says things he had once done sparingly became obsessions. An occasional fishing trip turned into fishing everyday. If there was a kareoke machine at a bar, he had to sing all his favorite songs.

One afternoon, Mills tried something he'd never done before. He gambled at a casino. Twenty dollars turned into $200 and he was hooked.

"I'd go with $100 and come back with nothing. Then the next time, I'd go with $500 and come back with nothing,” said Mills. There was times I'd take $5,000 to the casino in one day and it'd all be gone. At one point, I was at the casino everyday," he added.

At first, the gambling was a secret. But in a-year-and-half, his family was flat broke. Mills estimates he gambled and lost more than $500,000.

"Eventually, it got to the point where I had to sell my home, I lost my cars and it just got worse and worse," said Mills.

Before he developed Parkinson’s, Mills had never seen the inside of a cop car. But in a matter of months he was arrested three times for disturbing the peace and assault.

“I started losing friends, I lost my family, my mom, my brothers and sisters," said Mills.

Then he read a 2005 newspaper article. People from across the country told stories of compulsive eating, hypersexuality, daily shopping sprees and gambling addiction.

They were all Parkinson’s patients who had been prescribed drugs like Mirapex.

"Eighty percent of Parkinson’s Disease patients have probably at one point in their treatment been treated with these drugs," said Mayo Clinic Neurologist Dr. Zbigniew Wszolek.

Dr. Wszolek studied 1,411 patients. Six developed compulsive behavior. But Dr. Wszolek says the behavior is usually dramatic.

"Sometimes, reduction of the dose is sufficient. Sometimes, changing to another dopamine agonist can be helpful," said Dr. Wszolek.

"I went into the VA hospital and I said, 'y'all got to help me. I need to get off this medication,'" said Mills.

He stayed at the VA hospital in Gainesville for three days. Three weeks later, Mirapex was out of his life and so was the gambling.

"Completely gone probably two weeks after I was completely off the medication,” said Mills. "I have had no desire since then to gamble or anything," he added.

Mills is now prescribed Tasmar. In early 2006, he also underwent deep brain stimulation therapy.

All that's left from those years are bills, bad memories and 529 pages of medical records. They detail rampage and pain. Mills remembers some of it. Some of it he's reading about for the first time.

Mills has filed a law suit against the manufacturer of the Mirapex, Boehringer Ingelheim Pharmaceuticals. The company will not speak about the details of the suit, but in a statement to First Coast News the company writes:

“In 2004, we updated our U.S. prescribing information with new wording to inform health care professionals that we had received reports of compulsive behavior associated with Mirapex."

“Currently, we are working with some of the nation's leading medical experts to investigate the relationship, if any, between this class of medications and compulsive behavior."

Tremor drug linked to odd compulsions

Sun, 04 Jun 2006 00:00:00 -0700

Faced with steady deterioration from Parkinson's disease, Jim Sweet leapt at the chance to try a new drug that promised to relieve the tremors brought on by the death of cells deep in his brain.

Like older Parkinson's medicines, Mirapex could bolster the fading supply of a critical brain chemical called dopamine. It was a blessing for Sweet until something unusual started happening.

First, he started buying things in eBay auctions a camera, a reclining leather chair, a big-screen TV, sunglasses, costume jewelry and dozens of other items. He dived into online gambling, lottery tickets and penny stocks. Before long, he was disappearing for days to play slot machines at Indian casinos near his home in Rancho Cucamonga, Calif.

He ran through his savings and pawned his CD collection, his children's video game player and his wedding ring.

Gambling "was something I could not turn off," said Sweet, 45, a former middle school teacher.

Although Mirapex and similar dopamine drugs have helped thousands of Parkinson's patients, researchers are beginning to detect a small group for which the medicine seems to trigger bizarre out-of-control urges.

According to a recent University of Toronto study, as many as one in 15 patients taking the drugs - potentially thousands of people - might have such reactions.

An elderly California widower started wearing dresses, heels and lipstick; one man became obsessed with fast driving and abandoned his job to ride a Jet Ski up the California coast, according to a study by University of Southern California researchers.

The companies say they are monitoring reports, but so far the rate of compulsions does not exceed that of the general population. One company chalked up complaints to coincidence.

"If someone takes an aspirin and they gamble, does that mean the aspirin did it?" said Dr. David Hosford, a scientist at GlaxoSmithKline, maker of the dopamine drug Requip.

People who claim their lives were shattered by their strange urges have filed lawsuits against drugmakers. Although their compulsions disappeared after they stopped taking the drugs, some patients say they are still haunted by their experiences.

Sweet, who once studied for the ministry, said he can only guess where his compulsion came from.

He had barely been inside a casino before, although he remembered he and his wife once won $800 in Las Vegas. Thrilled, they bought an entertainment center for the family.

His life was happy and predictable - until one day his left arm froze against his side during a church league basketball game. Weeks later, his arm shook as he grasped the hand of a teammate to form a prayer circle.

They were the first signs of Parkinson's disease, which afflicts 500,000 to 1 million Americans, most of them elderly. Sweet was 38, with two young children.

Parkinson's is caused by the death of cells that produce dopamine, a neurotransmitter that carries messages along the brain's pathways. A shortage of the chemical causes poor coordination, shaking and bad balance. With time, symptoms include incontinence, difficulty talking and sudden paralysis. There is no cure.

Sweet soon began taking the standard Parkinson's drug, levodopa, which is converted to dopamine in the brain.

Although his tremors disappeared, Sweet knew the decades-old medicine carried some undesirable side effects, including involuntary tongue movements, grimacing and head bobbing. So he switched to Mirapex, marketed by German drug maker Boehringer Ingelheim. The drug, which did not carry those side effects, had been approved a year earlier for patients in the early stages of Parkinson's.

Half of Parkinson's patients in the U.S. now take Mirapex or similar drugs, which are also used to treat people with restless-leg syndrome and those with depression that doesn't respond to other medicines.

The changes began in a matter of weeks, Sweet said.

Sweet's wife, Kris, said she noticed him spending all his free time at the computer. For the first seven years of marriage, the couple never had a credit card balance. Now their debt was mounting from stock and online gambling losses.

"It was like being outside yourself, watching as you do these horrible things," he said. "I was still Jim. I still cared. I was trapped inside my mind."

Kris Sweet filed for divorce three times, but each time withdrew the court documents because she had a suspicion his disease was to blame. Still, she slept with her wallet under her pillow and hid her jewelry.

"I couldn't trust him," she said. "I had to protect the family."

Desperate to figure out what was happening to him, Jim eventually ended up at the University of California, Los Angeles.

Dr. Jeff Bronstein, a neurologist, tried to rein in Jim's gambling with counseling and drugs. There was no improvement.

One thing was left. Bronstein finally turned his attention to Jim's Parkinson's medication.

Around the U.S., other doctors had started noticing odd behaviors in their patients, and reports began appearing in medical journals.

Among the first was an August 2003 report in the journal Neurology that linked the drugs to gambling in eight Arizona patients. Although the rate was the same as in the general population, the drug appeared to act as a trigger in patients, who stopped gambling when the medicine was discontinued.

With each subsequent report, a fuller picture emerged. At a meeting of the Movement Disorders Society in 2004, Dr. Jennifer Hui, a neurologist, and her colleagues at USC said patients' odd behaviors weren't limited to gambling.

What friends and families dismissed as mid-life quirks or irresponsible behavior appeared to be drug-induced personality shifts making patients enamored with things they often had little interest in before, Hui said. She had patients who had become obsessed with golf, sex, home decoration and gardening.

The root of the phenomena, scientists suspect, is in the complex role of dopamine in the brain.

Not only does the chemical carry messages that convert thought to movement, but it also stimulates a part of the brain, the limbic region, that controls feelings of reward and well-being. Gambling, sex, addictive drugs and some habits, such as playing video games, are known to stimulate dopamine in the limbic region.

"Without dopamine we would never be addicted to cocaine, cigarettes, heroin or anything," said Northwestern University scientist D. James Surmeier.

Writing in Neurology last September, a team from the Mayo Clinic in Rochester, Minn., found that the dopamine drugs had a strong attraction to nerve cells found in large numbers in the limbic region and likely overstimulated the area.

Surmeier, a dopamine expert, called the link to cells in the limbic region "a smoking gun."

In February, a Food and Drug Administration study published in Neurology found a strong association between the drugs and pathological gambling, although the total number of complaints received by the agency was small.

The drug companies have added information about compulsive reactions to their package inserts. Boehringer Ingelheim said it was working with Parkinson's experts to investigate reports of pathological reactions.

Why compulsive reactions seem to grip only a minority of patients is a mystery. Some researchers speculate that genetic differences among individuals in the number and variation of dopamine receptors are to blame.

For patients who need the drugs to manage the inexorable progression of Parkinson's, options are limited. Lowering drug doses seems to eliminate compulsions in some patients, doctors say. Other patients have channeled their obsessions into more productive behaviors.

Sweet, meanwhile, still can't completely forget the three years when gambling overwhelmed his life.

After doctors at UCLA took him off Mirapex, "It was like a weight being lifted from my head," said Sweet, who recently settled a federal lawsuit against Boehringer Ingelheim and Pfizer Inc., which co-marketed Mirapex in the U.S.

His lost savings and poor credit weigh on his mind. A creaky step reminds his wife of how he would sneak out to a casino.

Even now, four years since he stopped gambling, his 12-year-old daughter still runs after him when he leaves to make sure he is coming back.

"For three years, they couldn't trust me at all," Sweet said. "It is going to take time to build up that trust again."

From Blessing to Curse?

Tue, 23 May 2006 00:00:00 -0700

Investigation: Secret Side Effects

Sun, 21 May 2006 00:00:00 -0700

What's more bizarre is that these drugs are used to treat many common ailments and you might be taking them.

What if you couldn't stop eating, longed for sex 24/7 or couldn't wait to gamble away your life savings.

Stories of strangers all over the country and each unaware they were linked by a common bond.

A pill they thought would help they say ultimately drove them to self-destruction.

A pill you may have in your medicine cabinet.

Fifteen years ago, 59-year old Brian Hearn was diagnosed with Parkinson's disease.

In 1997, drugs like it came on the market and the drugs worked.

What patients don't know is that the drugs may have been working overtime and over-stimulating part of their brain.

Hearn spent night after night gambling online, something he says he'd never done.

He almost lost his home and marriage.

Luckily, he mentioned the gambling, and the fact that he lost a quarter of a million dollars, to his doctor.

Almost immediately, they reduced his Mirapex.

Hearn says it was like turning a light switch to solve his problem.

And Brian is not alone.

In Texas, Max Wells says he gambled away $14 million on this class of drug.

He says his libido went out of control, contributing to the failure of his marriage.

In Philadelphia, Robert Seely killed himself and his wife.

A lawsuit blames an elevated dosage of Mirapex.

A doctor at the Mayo Clinic was one of the first to discover the connection between these drugs and the obsessive compulsive behavior.

While Mirapex is only FDA approved for Parkinson's, there's a trend experts say that could lead to many more victims.

Doctors are prescribing it for everything from depression to sleep disorders.

Reports have existed for years.

We discovered nearly a dozen.

Some doctors and others say the pharmaceutical companies never translated these reports to adequate warnings.

Experts say 100,000 or more could suffer these devastating obsessive compulsive effects.

Countless lawsuits blame the drug makers.

The makers recently strengthened the language on package inserts and tell us they are committed to patient safety, but victims say it's not enough.

They want bold labels right on the bottles.

The makers of Requip say there is no scientific connection between the OCD behavior and their drug.

Parkinson's drug linked to compulsive behaviors

Sat, 13 May 2006 00:00:00 -0700

A recent study seems to suggest that a drug used to treat Parkinson’s disease could be responsible for bizarre and compulsive behavioral changes in patients.

High-profile celebrities like Michael J. Fox and Muhammad Ali have put the spotlight on Parkinson’s disease.

But in addition, recent research has also shed light on the bizarre side effects of taking a drug called Mirapex used to treat the disease.

“We have seen compulsivity in the sexual area, patients who started to over-eat and gain a tremendous amount of weight, Dr. Richard Dewey said.

“We've seen compulsive spending and compulsive shopping.”

And compulsive gambling.

“I was all the way back to Longview before it occurred to me that I don't have $9,000 in the bank,” said Jacquie Rice, who lives in Longview, east of Dallas.

She was taking Mirapex for restless leg syndrome.

Rice said she gambled away nearly $200,000 before she realized what was happening and stopped taking Mirapex.

"I prayed real hard not to cry on this interview, but I have spent everything we have," Rice said.

A study conducted last year by the Mayo Clinic found 1 percent to 2 percent of participants experience behavioral changes while taking Mirapex.

“The whole problem is underrecognized, underpublicized,” Dewey said.

According to doctors, many patients are too embarrassed to say anything.

“Those are behaviors that people tend to hide, and they're also behaviors they don't connect with the medication,” said Dr. Alida Griffith, a movement disorder specialist.

In 2004, the Canadian company that makes Mirapex changed the packet of information that accompanies the drug to include wording about “compulsive behavior.”

But Rice and her husband say they should have been told about the side effects.

Now they are suing.

“I would like to get our money back,” Rice said. “I'm human. I'd really like to get our money back."

A move to give the lawsuits of Mirapex patients class action status was denied last year.

Many researchers agree that more definitive studies are needed to explore the possible connection between the drug and compulsive behavior.

Prescription For an Obsession?

Sun, 19 Mar 2006 00:00:00 -0800

When Wayne Kanuch received a diagnosis of Parkinson's disease in 1993, the last thing he imagined was that the drug prescribed to treat his illness would turn him into a compulsive gambler and put his libido into overdrive.

Kanuch's marriage ended in divorce, partly as a result of the sexual pressures he placed on his wife, and he began losing fortunes at the racetrack. He was fired from his job at Chevron for trolling for dates on the Internet while at work, and he quickly went bankrupt.

"I contemplated suicide a couple of times," he said in an interview last week. "Everyone was blaming me, and I was looking at the mirror and blaming myself and asking why I could not stop."

New evidence unearthed by scientists at the Food and Drug Administration, Duke University and other centers suggest the reason Kanuch could not stop is that the drug being used to treat Parkinson's boosted the level of dopamine in his brain. Researchers are looking into the possibility that dopamine, which is associated with a host of addictive behaviors, may turn some Parkinson's patients into obsessive pleasure seekers.

Now, some patients are suing the manufacturers of these drugs to recover the money they lost gambling, on the grounds that the companies did not do enough to warn about these risks. Kanuch has not yet sued but plans to do so.

So far, there is no definitive evidence on the connection between dopamine enhancers, known as agonists, and compulsive gambling. The behavioral anomalies, though dramatic, are probably rare among the thousands of Parkinson's sufferers who take the drugs. There have been no controlled studies looking into the possible link.

Drug manufacturers say anecdotal reports from patients such as Kanuch do not constitute scientific evidence, but they say they have updated warning labels anyway. Valeant Pharmaceuticals, which sells Permax, a dopamine agonist, said the matter is under litigation but it has told physicians: "As with other dopamine agonists, compulsive self-rewarding behavior (e.g., pathologic gambling) and libido increase have been reported in patients."

Boehringer Ingelheim, which makes Mirapex, another dopamine agonist, said it has toughened its warning label but said that company officials are still exploring the connection. Eli Lilly & Co, which used to sell Permax, said there is no scientific consensus on the issue and suggested that gambling problems may be linked to the increased accessibility of legalized gambling.

Still, a recent analysis headed by FDA scientist Ana Szarfman found a strong association between pathological gambling and dopamine agonists. The statistics from a federal adverse-events database are not conclusive, but FDA officials regularly mine the data to spot red flags.

"There is decent biochemical plausibility that chemical changes can lead to impulsivity and acts like pathologic gambling," said Duke University psychiatrist P. Murali Doraiswamy, co-author of the analysis, published in Archives of Neurology.

"It is certainly plausible that gambling can be a side effect of a drug that excessively stimulates limbic-system dopamine," Doraiswamy said.

The notion that brain chemicals play a powerful but hidden role in human behavior is at odds with American convictions about free will and choice. Kanuch and other patients said they spent years believing they were responsible for their actions, only to find that the impulse for self-destructive behaviors vanished once they stopped taking a drug.

"I broke down in tears and cried my heart out," Kanuch said. "I could not believe a drug could cause that kind of problem. The more I read, I grew convinced and grew angrier."

Several patients said the behaviors proved so destructive that they preferred the diseases that the medications were trying to treat.

Kanuch, 52, who shuttles between living arrangements in the Texas towns of Missouri City and Katy after bankruptcy and several evictions and run-ins with the law, said he is planning to file suit against the maker of Mirapex. The man who had a 21-year career with Chevron said he lost $350,000, his marriage and numerous friends from whom he borrowed money for gambling.

"I was misled by doctors," he said. "They may not know all the side effects, but as early as 1993 there was case history building. My doctor was not aware of this. When I told him there was an issue, he denied there was a problem."

Several other patients report similar obsessions. Cindy Still of Roseburg, Ore., said that after 29 years of faithful marriage, another dopamine agonist, a physician thought the drug might help ease her chronic depression caused her to start an affair, quit her religion and become a compulsive gambler.

Peggy Andresen, 51, of Redmond, Wash., developed obsessions with gambling and painting tables and counters to look like marble. Mirapex is a great drug, she said, but "the top of every bottle needs to have a big red sticker that says 'May Cause Gambling.' "

Barbara Hermansen, 52, of Winnetka, Ill., said she was prescribed Permax in 1996 for restless-leg syndrome, in which patients feel electrical impulses crawling under their skin when they lie down to sleep and causing debilitating bouts of insomnia.

The drug worked like a charm, and her physician steadily increased the dose, which tends to be necessary by 2001, she was on 40 times her original dose. On a weekend visit to Las Vegas with her sister, Hermansen dropped $300, which surprised the Sunday-school teacher because before that she had been in a casino twice before and could not wait to get out.

On returning home, the financially conservative lawyer began gambling over the Internet. She maxed out her credit cards, emptied her retirement accounts and sold jewelry to fuel the gambling. When she confessed to her husband after losing about $15,000, she said he was incredulous because she had been so staid when it came to finances.

Hermansen promised she would never do it again, and she put a filter on her computer to block the gambling Web sites. She soon found herself driving to casinos. After confessing again, she got herself voluntarily banned from Illinois casinos. Then she started driving to casinos in Indiana.

"I won huge amounts of money," she said. "I stood in front of a machine and won $62,000 and $28,000 in single spins."

But, as is true for many people with gambling problems, the money proved to be almost beside the point. With one exception, she never walked out of a casino with money: "You never walk away, you always put it back in, because no amount of money is enough," she said.

When a grocer gave her a bottle of champagne for being such a good customer for scratch-off lottery tickets, Hermansen said she was so humiliated and disgusted at herself that she wished "the earth would open and swallow me."

By 2004, believing she could never stop, she resolved to drown herself by taking a sleeping pill and swimming out into Lake Michigan. But as she sat in her car with her bathing suit beside her and a sleeping pill in her pocket, she realized she could not bear to leave her husband and children.

When Hermansen asked her neurologist if the drug might be the problem, he said he did not know of a connection. At a Gamblers Anonymous meeting, the theory was booed down and she was told she needed to take responsibility for her actions. A therapist suggested she was testing her husband's love because she felt she didn't deserve to be happy; a psychiatrist told her to make a list of all the reasons she was trying to sabotage her life.

When an expert in pathological gambling finally took her off the drug, the urge to gamble vanished. The restless-leg syndrome came back with a vengeance, but Hermansen swears that she would rather "suffer from insomnia for the rest of my life rather than go through that gambling hell."

Hermansen sued Eli Lilly to recover hundreds of thousands of dollars she lost gambling, and because she says the company was unresponsive to her plea for warnings.

A move to turn the lawsuits into a class action was denied late last year, because of the diversity of the cases, and now individual lawsuits are accumulating around the country, said, a lawyer in Rancho Cucamonga, Calif. This lawyer is representing Joe Neglia of Millersville, Md., a former Defense Department intelligence analyst who turned to compulsive gambling after taking Mirapex for Parkinson's disease.

The palntiff's attorney dismissed the existing warnings as too little too late: "The warning label is a joke," he said. "To bury five to six words on Page 17 when the effects are so catastrophic is ridiculous. You need a clear descriptive warning label and notification to doctors to ask patients about this potential effect."

Parkinson's drug can cause compulsive gambling

Wed, 01 Mar 2006 00:00:00 -0800

A Mayo Clinic specialist discusses the link between a Parkinson's drug and compulsive gambling. This rare side effect might help future researchers develop treatments for addiction.

People who had never seriously gambled before suddenly were losing thousands of dollars at casinos sometimes more than $100,000. Men who had been content with once-a-week sex began having sex three and four times a day. Some began to overeat, gaining 50 pounds in just a few months.

What did all these people have in common besides their compulsive behavior? They were all taking a type of medicine, called dopamine agonists, to treat Parkinson's disease. Most of these people were taking one specific dopamine agonist: pramipexole (Mirapex).

M. Leann Dodd, M.D., a psychiatrist at Mayo Clinic, Rochester, Minn., was the lead author of a recent study that shed light on the surprising link between dopamine agonists and the sudden onset of compulsive behavior. In this interview, she answers a few questions about the topic.
How did this connection come to light?

It started coming up at doctor appointments. Patients or their family members would bring it up. It was mostly gambling, but over half of our patients also manifested other compulsive behaviors, such as hypersexuality or compulsive overeating.

It started out as a curiosity, but then we found case reports that showed there might be some connection between this compulsive behavior and a particular type of medication. When people were tapered off these medications, the compulsive behavior would go away. It was a dramatic resolution of the behavior in many of the cases.
What's special about this drug?

People who have Parkinson's are deficient in a brain chemical called dopamine. Dopamine agonists are a synthetic version of dopamine that bind to dopamine receptors in the brain. Pramipexole binds to one particular type of dopamine receptor the dopamine receptor D3 much more than to other dopamine receptors.

These D3 receptors are highly concentrated in the area of the brain devoted to mood, behavior and rewards. It's exciting to think that future studies may reveal more about how the D3 portion of the brain may be associated with addictive behavior. Ultimately, such studies could lead the way to development of medications that curb addictive behavior in general.
Is pramipexole used for other problems?

Pramipexole is also commonly used to treat restless legs syndrome, but at much lower dosages than those used for Parkinson's disease. A common dosage for restless legs is 0.125 milligrams (mg) a day, while the daily dosage for Parkinson's is more like 4.5 mg.

We haven't yet seen a link between compulsive gambling and pramipexole at these lower dosages. But that's not to say it's not possible.
How often does this side effect occur?

A study of 529 people taking pramipexole for Parkinson's symptoms revealed that 1.5 percent of them had developed compulsive gambling behaviors. Our study evaluated only 11 people, all with Parkinson's, and all of whom had started gambling compulsively while being treated with dopamine agonists.

Studying this select group demonstrated the connection between the drug's strongly selective binding to the D-3 receptors and the development of compulsive gambling. We also measured how long it took for the behaviors to appear after starting on the drug. Most of the people who developed gambling behaviors did so within a month or two. Some took longer.
This drug was approved in 1997. Why are we only seeing this connection now?

Compulsive gambling, hypersexuality and overeating those are things that are not normally associated with Parkinson's medications. And they're pretty embarrassing behaviors. A lot of people are just not going to share these things with their doctors. Even their doctors may not have been aware of this possible connection.

Our key point is to let the public know that they need to tell their doctors when something's amiss. If you start behaving in a way that's out of character for you, you need to talk to your doctor, even if it's embarrassing. We also want to educate physicians about this connection, so they can let their patients know that this side effect is a possibility it is crucial to make this association because these effects are potentially reversible.
Can people get hurt by stopping the drug abruptly?

This is a very good medicine for the treatment of Parkinson's, and people should not just stop taking it on their own. This side effect is very rare. If people think they are experiencing compulsive behavior because of the drug, they should talk to their doctors about it. It might be best to taper off the drug. However, several people in our study abruptly stopped taking the drug, and they didn't experience any worrisome problems.

How is this new information helping people?

One lady, from a family with a modest income, lost $100,000. Her husband and children left her. She remarried and her second husband was about to leave her. She stopped taking the drug and within two weeks the gambling compulsion disappeared.

In a few tragic cases, people have lost their financial security and their relationships. My e-mail box has been flooded with people telling their stories. One man said his wife woke him up, crying, with a newspaper article about this study in her hand. She's had a gambling addiction for two years and now they're hopeful that they've found a possible answer.

Parkinson's medicine has odd side effect: Gambling

Wed, 01 Mar 2006 00:00:00 -0800

A 52-year-old married man had gambled away more than $100,000 when his wife finally asked for help.

She didn't call Gamblers Anonymous. Instead, she talked to the Mayo Clinic doctor who had been treating her husband for Parkinson's, an incurable brain disorder.

M. Leann Dodd of the Mayo Clinic in Rochester, Minn., and a team of neurologists identified 11 cases in which compulsive gambling had developed almost overnight in people who were taking medication for Parkinson's.

"Most of these patients had no idea this gambling problem was connected to their Parkinson's medication," Dodd says. She and her colleagues described the cases last year in the Archives of Neurology.

The study and others like it that suggest that Parkinson's medication might trigger a gambling urge for some patients serve as a warning for the estimated 1 million people in the USA who have the disease. But such research also might help millions of Americans who have a gambling habit.

"The research may teach us about pathological gambling in the general population," says Mark Stacy, a Duke University neurologist who outlined the evidence on Parkinson's and gambling Sunday at the World Parkinson Congress in Washington, D.C.

The growing body of research includes a study published in February in the Archives of Neurology. Ana Szarfman of the Food and Drug Administration used a computer program to search the FDA's national database to see whether there were any reports of gambling linked to prescription drugs.

Szarfman and her colleagues discovered 67 cases of gambling. Medications used to treat Parkinson's accounted for most of those, but one Parkinson's drug stood out: Pramipexole or Mirapex had 39 reports of gambling. This drug alone accounted for 58% of the cases of gambling reported to the FDA, says co-author P. Murali Doraiswamy, who is also at Duke University.

This study doesn't prove that Parkinson's drugs can trigger gambling. "We're not saying this is cause and effect," he says.

But the evidence so far does fit together with what is known about how these drugs affect the brain, Dodd says.

These drugs act on specialized receptors in the limbic system, a brain region that controls emotions. When it is overstimulated, it can lead to impulsive behaviors, such as compulsive gambling, according to a Mayo Clinic release.

Right now, the gambling problem seems to be a rare side effect of drugs that also offer relief for Parkinson's symptoms, Stacy says.

Second Parkinson's Drug, Requip, Blamed for Compulsive Gambling that Cost Retired Doctor $14 Million

Sun, 26 Feb 2006 00:00:00 -0800

Up until now, Mirapex has been the medication most often associated with the mounting medical evidence linking certain drugs used to treat Parkinson’s disease (PD) to the development of compulsive behavior, including pathological gambling.

Now, however, a second drug has been thrust into the same spotlight with the filing of a $14 million lawsuit by a retired doctor who claims that Requip, a drug very similar to Mirapex, turned him into a compulsive gambler.

Dr. Max Wells alleges in the action commenced in U.S. District Court in Austin, Texas, that his addiction made him a habitual high roller at Las Vegas casinos where he lost $7 million by late 2005 and another $7 million by January of this year.

As reported by The Oxford Press (Oxford, Ohio), the complaint names the drug’s manufacturer, GlaxoSmithKline (GSK – sued as SmithKline Beecham), the world’s second largest pharmaceutical company, and seven casinos, including Mandalay, Treasure Island, Bellagio, Wynn Las Vegas, Las Vegas Sands, Harrah's Las Vegas and Hard Rock Hotel.

At the heart of the doctor’s lawsuit is the Mayo Clinic study published last July in the Archives of Neurology that identified 11 Parkinson’s patients who developed a gambling habit while taking Mirapex or Requip between 2002 and 2004. After the study was released, 14 additional Mayo patients were diagnosed with the problem according to lead author Dr. M Leann Dodd, a psychiatrist at the Clinic.

Previously, in August 2003 in the journal Neurology, Drs. E. Driver-Dunckley, J. Samanta, and M. Stacey published an article entitled “Pathological gambling associated with dopamine agonist therapy in Parkinson’s disease.”

That study found extreme cases of compulsive gambling in nine (of 1,884) patients using pramipexole (8 or 1.5%)) and pergolide (1 or 0.3%). Both results were well above the overall incidence rate of all PD patients of 0.05%. Both drugs that showed an increased risk were dopamine agonists (DA).

The Mayo Clinic study also analyzed the findings in five prior studies (including the 2003 Driver-Dunckley study) and confirmed that: “All of the commonly prescribed dopamine agonists have been associated with pathological gambling” with pramipexole being “disproportionately represented in both our series (82% of our patients) and in prior reports (59%).”

Mirapex (pramipexole dihydrochloride) is in the dopamine agonist class of drugs and is believed to work by mimicking the action of dopamine in the brain to help control the symptoms of Parkinson’s disease.

Dopamine also affects brain processes that control emotional responses and a person's ability to experience pleasure and pain. It is thought to play a role in addictive behavior.

As we previously reported, these medications present another example of drugs whose benefits come with a very high price tag for some patients. The ones who become addicted to gambling often wind up losing their life savings, fall deeply into debt, and even jeopardize or destroy their marriages or other personal or family relationships.

In the past, the victims of this harsh side-effect had no idea what had come over them. Their brain was literally taken over and their gambling became constant and compulsive. Simply stated, they were out of control and had no idea why. For these people, the situation was frightening and inexplicable.

As a result of this completely bizarre and damaging side-effect, many Mirapex and Requip users suffered long periods of debilitating and destructive behavior during which they were unaware that the drug was causing the problem and that it would cease if they discontinued taking it.

Mirapex is manufactured by German-based Boehringer Ingelheim Pharmaceuticals, the world's biggest family-owned drug company, in cooperation with New York-based Pfizer, the world's largest drugmaker. Its sales for 2004 topped $200 million in the U.S. alone.

.Boehringer Ingelheim lists "compulsive behaviors (including sexual and pathological gambling)" as a possible side effect associated with taking Mirapex. That seven-word phrase on page 17 of a 21-page highly technical document is all the warning that is given concerning the potentially detrimental side-effect.

While Boehringer-Ingelheim has repeatedly claimed there is no scientific evidence upon which to base the conclusion that Mirapex causes addictive or compulsive behavior, the multiple reputable studies on the subject would seem to indicate otherwise. In addition, the company revised its package insert to include the warning with respect to “compulsive behavior” despite its denial of the connection.

Now, additional evidence of the association between Mirapex and other dopamine agonists and impulsive behavior has appeared in the form of an analysis of adverse drug reports in the FDA’s database. Of the reports specifically dealing with compulsive gambling, 39 (58%) involved Mirapex.

The report, which analyzes these adverse events, appears in the February issue of Archives of Neurology. The authors include a psychiatrist, P. Murali Doraiswamy (Duke University), and three FDA scientists.

According to Dr. Doraiswamy: "When you combine this with other pieces of evidence, it seems highly suggestive that there is a causal relationship."

While the evidence is consistent with other findings linking dopamine agonists with an increased risk of impulsive behavior, the researchers claim to have found no similar reports involving antipsychotic drugs, which inhibit dopamine.

Boehringer Ingelheim has now backed off its hard line denial of a link just a bit by stating that it is working with Parkinson’s experts to “investigate the relationship if any.”

GSK claims that its drug, Requip, is appropriately labeled with respect to potential side-effects.
Dr. Wells claims that the casinos were aware that he had PD and that he was on medication for the disease while he was gambling.

Wells had originally been taking Mirapex for his PD but, when he noticed his occasional recreational gambling had become more serious, he told his doctor that he thought that drug might be the cause. His doctor changed his medication to Requip and increased the dosage.

Although Wells then began running up massive gambling losses and some $1.2 million in debts that remain unpaid, his wife remained unaware of the problem since she was not present when the losses occurred.

When Wells finally told his wife about the losses, the problem was brought to the attention of his physician. As soon as the Requip was stopped, so did the compulsive gambling.

The behavioral changes witnessed in some Parkinson’s patients whose therapy includes dopamine agonists can be wide-ranging indeed. On the mild side, some start buying lottery tickets and nothing more. Others, however, have been known to develop serious OCD (obsessive compulsive disorders) as well as aggressive sexual impulses, overeating, medication abuse, or pathological gambling.

Since these personality changes are dramatic and involve conduct that the patient has usually not exhibited in the past, relatives and associates should be aware of the potential problem and remain watchful for marked behavioral changes.

PD causes sufferers to gradually lose dopamine. Thus, they actually develop an aversion to the type of impulsive behavior associated with excess dopamine. When Mirapex, Requip, or another dopamine agonist is introduced, the behavioral changes in those adversely affected can be both quick and dramatic.

Currently, two major lawsuits against Boehringer Ingelheim and Pfizer have been commenced in federal court in California and in Superior Court in Ontario, Canada. They allege a number of addictive behaviors associated with Mirapex including gambling, shopping, having sex, eating, and engaging in other compulsive conduct.

It is likely that additional lawsuits will be commenced in the near future since the problem is as widespread as the locations of people who took Mirapex or Requip.

Gambler blames Parkinson's for his addiction

Fri, 24 Feb 2006 00:00:00 -0800

After gambling away $14 million, a retired physician from Austin, Texas, is making one last bet, that he'll recover his loss by suing casinos and the makers of his Parkinson's medication.

Dr. Max Wells says the drug company failed to warn patients that Requip and a similar drug called Mirapex could cause compulsive gambling. He also says Las Vegas casinos, including the Wynn, Bellagio and Harrah's, share the blame because they let him gamble, even though they knew he was on the medication and compulsive about it.

Dr. Wells' attorney, Tom Thomas, joined Tucker Carlson, on ‘Sitiuation’ to discuss his client’s case.

To read an excerpt from their conversation, continue to the text below. To watch the video, click on the "Launch" button to the right.

TUCKER CARLSON, HOST, ‘SITUATION’: Now, I understand that there's a likelihood that this medication did make your client compulsive about gambling; whether it made him a compulsive gambler is a different question. Let's just say that right off the top. I think it's possible.

TOM THOMAS, ATTORNEY FOR DR. MAX WELLS: Yes, there are some studies. Mayo Clinic published one in '05. There's been one as recently as three weeks ago. There's no doubt that in a number of these patients that they're compulsive gambling.

CARLSON: Yes, I absolutely believe it. But this guy lost $14 million. OK.

THOMAS: Yes. His life savings.

CARLSON: After about, say, a million dollars or $7 million or even, say, $10 million, why didn't he seek treatment?

THOMAS: It wouldn't have made any difference if it had been $100 million. If you've got a compulsion, you can't stop.

CARLSON: Well, you can tell other people you have a compulsion. Of course you can stop. I know a million compulsive drinkers. I know some compulsive gamblers who've stopped. I mean, there are a lot of people with compulsions who either control them or turn to other people to help them control them. Why didn't your client do that?

THOMAS: Because he's taking a drug. You can't control it when you're taking the drug that creates the compulsion. You can only control it by stopping to take the drug.

CARLSON: But he must have been aware that he was losing millions and millions and millions of dollars, correct?

THOMAS: You know, he was aware of it. But the compulsion overcame the feelings that you describe that most of us would have. You're importing or assuming and properly and understandably so a rational train of thought. That's one of the evils of this particular problem, is it destroys rationality. No rational person would squander $14 million in 10 months.

CARLSON: There's no question your client's insane, whether it's the drug's fault or not. Of course, you lose $14 million it's bad.

I'm just saying that people with compulsions to drink, to do drugs, to gamble, are not completely insane. They understand they're destroying themselves, and that's why many of them reach out to other people to help them. There is an element of free will in this disease, even if you're taking Parkinson's medication. So why didn't he do that?

THOMAS: There's not much of an element of free will when you're choosing between the only drug that will give you any normalcy in your life and a byproduct that you don't know is being created by that drug.

CARLSON: I guess I'm not going to ask you for a fifth time why he didn't go to Gamblers Anonymous. Why didn't his wife pipe up? Apparently, the Las Vegas casinos treated them like the whales they were, and sent them on a cruise to Alaska, and gave them all kinds of comps. She must have known.

THOMAS: She didn't know how much. If you've been to Las Vegas, you know wives don't gamble with husbands. And he had his own—their money separately. She didn't know.

CARLSON: Did a casino send your client on a cruise to Alaska?

THOMAS: They did. She knew that they were gambling money. She had no idea it was in the millions.

CARLSON: OK. Well, I'm sure she didn't. But I mean, she couldn't have imagined she was being sent on a cruise because her husband was winning at the craps table, correct?

THOMAS: I don't know what she imagined about that. She's a high school math teacher. I don't think she knows beans about it.

CARLSON: She does now.

THOMAS: She does now. And in fact, it was her ultimate questioning that led to Max's seeking some help where he was taken off the drug.

CARLSON: Wait. Just to go back to something you said. She's a math teacher you said?

THOMAS: Yes, she's a math teacher.

CARLSON: But not obviously, not a very good math teacher if she couldn't figure out that he was losing a lot of money.

THOMAS: Now, that's not so. You can't draw that conclusion if you don't know what's happening.

CARLSON: Well, because your case rests on the notion that he is notand his wife, by extension is not in any way responsible for losing all this dough. And I'm just suggesting that a math teacher and an aware human being might suspect that something was terribly wrong.

Where did the $14 million come from, anyway?

THOMAS: He sold his practice when he had to retire because of the Parkinson's.

CARLSON: Do you think there's any chance you're going to get this money back?

THOMAS: Sure there's a chance I'm going to get this money back.

CARLSON: From the casinos or from the drug company?

THOMAS: Both. The drug companies have an obligation to warn what they know about, if it's a threat, and they didn't do that. If they would had warned him, like anybody else, or most other drugs, then he could have gotten the help or taken the steps that he ultimately did once the warnings came out.

CARLSON: Finally, has any Las Vegas casino ever returned money to a person who claims he's a compulsive gambler?

THOMAS: You know, I don't know the answer to that. The ones that I do know about, the ones that went to final judgment, they did not. I do know there have been several settlements where they have, in fact.

CARLSON: Boy, if you win this, they're in deep trouble.

THOMAS: No, they really won't be. This is a very unique statute that we have in Texas that we're suing under. This isn't just generally saying give the money back because X, Y and Z. This is saying give the money back because we have a very specific statute in Texas that I think prohibits what happened here. So I can't imagine this case would ever repeat itself.

Doctor sues drug company, casinos after losing $14 million

Wed, 22 Feb 2006 00:00:00 -0800

When the retired doctor from Austin suddenly began spending big money at the casinos, the casinos assigned him a "host," and gave him first-class airfare to Las Vegas, free hotel suites and meals, and shopping trips for his wife, according to a lawsuit filed in federal court in Austin.

The casinos even gave him an Alaskan cruise, the lawsuit says.

The retired doctor, Max Wells, kept coming back, the lawsuit says and kept losing money. By the fall of 2005, Wells had lost $7 million, the lawsuit says. By January, another $7 million.

Now Wells is suing the casinos and a major drug company, claiming that the prescription drugs he was taking for Parkinson's disease set off a compulsive gambling spree.

Wells, 55, wants his money back. He declined to comment Tuesday.

His lawsuit, filed Friday, says the drug company didn't warn patients that the drug Requip could cause compulsive behavior. And it cites a 2005 Mayo Clinic study that found 11 Parkinson's patients who developed compulsive gambling habits while taking Requip and a similar drug called Mirapex. The gambling ceased for eight of the 11 when they stopped taking the drugs; test results were not available for the other three patients, the study said.

GlaxoSmithKline, which is referred to as SmithKline Beecham in the lawsuit the companies merged in 2000 said it had not yet been served with the lawsuit Tuesday.

"We will certainly investigate the allegations when we receive the complaint," said Mary Anne Rhyne, a company spokeswoman. "We believe the drug is appropriately labeled."

The lawsuit claims the casinos knew Wells, 55, had Parkinson's, a degenerative disorder which damages nerve cells and causes shaking, slowness and difficulty with balance. Wells told the casinos he had Parkinson's, said his lawyer, Tom Thomas with Winstead Sechrest & Minick in Dallas, and he "was taking the medication while he was gambling."

The lawsuit says the casinos should have been aware of the Mayo study, which Thomas said was heavily publicized in Las Vegas during the summer of 2005.

None of the seven casinos named in the lawsuit returned calls Tuesday. They include Mandalay, Treasure Island, Bellagio, Wynn Las Vegas, Las Vegas Sands, Harrah's Las Vegas and Hard Rock Hotel.

Wells, a retired pathologist, was first diagnosed with Parkinson's disease in 2000, according to the lawsuit. After taking Mirapex for several months in 2004, Wells "developed an irresistible compulsion to gamble," the lawsuit said.

Wells, who Thomas said had been an occasional gambler, lost several thousand dollars gambling in Las Vegas and on the Internet, according to the lawsuit. After he told his doctor that he thought Mirapex was causing him to gamble, his physician switched him to Requip and increased the dosage, the lawsuit said.

As Wells was losing $14 million which included about $1.2 million in IOUs called markers that Wells hasn't paid his wife was unaware of his losses because she wasn't gambling with him, Thomas said.

During the last week of January, Wells' wife began to question him and he confessed to the losses, the lawsuit said. When his doctor took him off Requip, his gambling compulsion stopped, Thomas said.

Despite the losses Wells claims, he's not bankrupt, Thomas said.

"I would say he hasn't lost the farm, but he's lost the ranch," he said.

Research Continue to Link Certain Parkinson's Drugs, Especially Mirapex, to Compulsive Gambling and Other Impulsive Behavior

Wed, 15 Feb 2006 00:00:00 -0800

As previously reported by newsinferno.com, the medical evidence has been mounting with respect to the rather odd connection between certain drugs used to treat Parkinson’s disease (PD), especially Mirapex, and the development of compulsive behavior including pathological gambling.

Last July, a Mayo Clinic study published in the Archives of Neurology that identified 11 Parkinson’s patients who developed a gambling habit while taking Mirapex or similar drugs between 2002 and 2004. After the study was released, 14 additional Mayo patients were diagnosed with the problem according to lead author Dr. M Leann Dodd, a psychiatrist at the Clinic.

Previously, in August 2003 in the journal Neurology, Drs. E. Driver-Dunckley, J. Samanta, and M. Stacey published an article entitled “Pathological gambling associated with dopamine agonist therapy in Parkinson’s disease.”

That study found extreme cases of compulsive gambling in nine (of 1,884) patients using pramipexole (8 or 1.5%)) and pergolide (1 or 0.3%). Both results were well above the overall incidence rate of all PD patients of 0.05%. Both drugs that showed an increased risk were dopamine agonists (DA).

The Mayo Clinic study also analyzed the findings in five prior studies (including the 2003 Driver-Dunckley study) and confirmed that: “All of the commonly prescribed dopamine agonists have been associated with pathological gambling” with pramipexole being “disproportionately represented in both our series (82% of our patients) and in prior reports (59%).”

Mirapex (pramipexole dihydrochloride) is in the dopamine agonist class of drugs and is believed to work by mimicking the action of dopamine in the brain to help control the symptoms of Parkinson’s disease.

Dopamine also affects brain processes that control emotional responses and a person's ability to experience pleasure and pain. It is thought to play a role in addictive behavior.

Unfortunately, this is another drug whose benefits come with a very high price tag for some patients. The ones who become addicted to gambling often wind up losing their life savings, fall deeply into debt, and even jeopardize or destroy their marriages or other personal or family relationships.

In the past, the victims of this harsh side-effect had no idea what had come over them. Their brain was literally taken over and their gambling became constant and compulsive. Simply stated, they were out of control and had no idea why. For these people, the situation was frightening and inexplicable.

As a result of this completely bizarre and damaging side-effect, many Mirapex users suffered long periods of debilitating and destructive behavior during which they were unaware that the drug was causing the problem and that it would cease if they discontinued taking it.

Mirapex is manufactured by German-based Boehringer Ingelheim Pharmaceuticals, the world's biggest family-owned drug company, in cooperation with New York-based Pfizer, the world's largest drugmaker. Its sales for 2004 topped $200 million in the U.S. alone.

Boehringer Ingelheim lists "compulsive behaviors (including sexual and pathological gambling)" as a possible side effect associated with taking Mirapex. That seven-word phrase on page 17 of a 21-page highly technical document is all the warning that is given concerning the potentially detrimental side-effect.

While Boehringer-Ingelheim has repeatedly claimed there is no scientific evidence upon which to base the conclusion that Mirapex causes addictive or compulsive behavior, the multiple reputable studies on the subject would seem to indicate otherwise. In addition, the company revised its package insert to include the warning with respect to “compulsive behavior” despite its denial of the connection.

Now, additional evidence of the association between Mirapex and other dopamine agonists and impulsive behavior has appeared in the form of an analysis of adverse drug reports in the FDA’s database. Of the reports specifically dealing with compulsive gambling, 39 (58%) involved Mirapex.

The report, which analyzes these adverse events, appears in the February issue of Archives of Neurology. The authors include a psychiatrist, P. Murali Doraiswamy (Duke University), and three FDA scientists.

According to Dr. Doraiswamy: "When you combine this with other pieces of evidence, it seems highly suggestive that there is a causal relationship."

While the evidence is consistent with other findings linking dopamine agonists with an increased risk of impulsive behavior, the researchers claim to have found no similar reports involving antipsychotic drugs, which inhibit dopamine.

Boehringer Ingelheim has now backed off its hard line denial of a link just a bit by stating that it is working with Parkinson’s experts to “investigate the relationship if any.”

The behavioral changes witnessed in some Parkinson’s patients whose therapy includes dopamine agonists can be wide-ranging indeed. On the mild side, some start buying lottery tickets and nothing more. Others, however, have been known to develop serious OCD (obsessive compulsive disorders) as well as aggressive sexual impulses, overeating, medication abuse, or pathological gambling.

Since these personality changes are dramatic and involve conduct that the patient has usually not exhibited in the past, relatives and associates should be aware of the potential problem and remain watchful for marked behavioral changes.

PD causes sufferers to gradually lose dopamine. Thus, they actually develop an aversion to the type of impulsive behavior associated with excess dopamine. When Mirapex, Requip, or another dopamine agonist is introduced, the behavioral changes in those adversely affected can be both quick and dramatic.

Currently, two major lawsuits against Boehringer Ingelheim and Pfizer have been commenced in federal court in California and in Superior Court in Ontario, Canada. They allege a number of addictive behaviors associated with Mirapex including gambling, shopping, having sex, eating, and engaging in other compulsive conduct.

It is likely that additional lawsuits will be commenced in the near future since the problem is as widespread as the locations of people who took Mirapex.

Jerrold Parker, managing partner of Parker & Waichman, a law firm with considerable experience in pharmaceutical and medical malpractice litigation nationwide, told us after the release of the Mayo Clinic study that: “It is difficult to imagine how the manufacturers of Mirapex can maintain there is no scientific evidence to support the addiction link when several studies leave little doubt of the connection. In addition, it is rather amazing that when the manufacturers finally decided to add a warning regarding compulsive conduct to the product insert they chose to hide it in the middle of 21 pages of technical data.”

When asked to comment on the most recent research report, Mr. Parker stated: “The evidence is only growing stronger. The link between Mirapex, and the dopamine agonist class of drugs, and an increased risk of dangerous compulsive behavior is really undeniable. Only a radically conservative scientist and the drug’s manufacturer would still need more proof that a serious problem exists.

Parkinson's Drug May Cause Compulsive Gambling

Wed, 15 Feb 2006 00:00:00 -0800

Medicine used to treat Parkinson's disease has an unusual side effect: compulsive gambling, according to the Food and Drug Administration.

The agency said an analysis of adverse drug effects found that the strongest association with gambling was for Mirapex (pramipexole), which accounted for 39, or 58%, of reports of pathological gambling. Five other Parkinson's drugs also showed elevated risks.

The results were drawn from an FDA database of more than 2.5 million adverse drug reports dating back to 1968.

The latest results are consistent with earlier observations and add to evidence that Parkinson's drugs may lead to impulsive behavior as they make up for depleted dopamine, a brain chemical whose deficiency marks the disease.

The findings appear in the February issue of the Archives of Neurology.

An earlier article in the journal described 11 Parkinson's patients who developed pathological gambling after being treated with drugs for Parkinson's disease.

A spokesman for Boehringer Ingelheim, the German company that makes Mirapex, said the company is working with Parkinson's disease experts "to investigate the relationship, if any" between Parkinson's drug therapy and compulsive behavior.

Controlling Your Impulses After Parkinson's Treatment

Mon, 06 Feb 2006 00:00:00 -0800

In identifying a new type brain disorder, Dr. James Parkinson described his first patient as a humble gardener who led a life of "remarkable temperance and sobriety." Such personality traits, as well as the doctor's name, are now synonymous with a condition that affects more than 1.5 million Americans.

Since Parkinson's was discovered, doctors have noticed that a number of people who go on to develop the disease tend to be cautious, morally resolute and uninterested in seeking out new experiences. Indeed, some studies suggest that smokers or alcohol drinkers are at a lower risk for Parkinson's.

But with the advent of powerful new treatments, researchers have seen a Jekyll and Hyde personality emerge as well. In study after study, patients who are treated for Parkinson's sometimes exhibit a range of unsettling characteristics, such as gambling, overeating and obsessive compulsive disorders. They may also abuse their medications and even make inappropriate sexual advances.

Overall, these types of behavior are rare. Only about five percent of patients treated for Parkinson's exhibit such impulse control problems. But these changes can be quite serious, especially if they lead to addiction or sexual harassment.

"There are different levels of severity," says Dr. Matthew Menza, a professor of psychiatry and neurology at the Robert Wood Johnson Medical School in New Jersey.

Some personality changes can be relatively harmless, such as starting to buy lottery tickets, as one of Menza's patients did. As long as this doesn't break the bank, there is little reason to alter treatment, he says. Others, however, may experience a much more dramatic transformation.

"You sometimes see very aggressive sexual impulses," says Menza. "This can be so out of character with what that person has ever done before."

The Wrong Kind of Reward

Such an odd shift in behavior, while not fully understood, seems to be based on the amount of dopamine circulating in the brain. This chemical is believed to act as a natural reward mechanism, helping to control how we define pleasure.

When dopamine is at a normal level, there is less of a need to seek outside stimulation. But when the chemical is out of kilter, researchers have found the people are prone to all kinds of vices, from obsessive eating to becoming addicted to drugs.

Parkinson's patients, who gradually lose dopamine because of the disease, have a natural aversion to these types of sensations, Menza says. This can quickly change when a person is given a dopamine-boosting drug.

"The same would probably be true for anyone who tried them," says Menza.

Those who need these medications face a range of problems. This past fall, a team from the Mayo Clinic found that Parkinson's patients who have never seriously gambled before were all of a sudden losing thousands of dollars at a casino after starting treatment. More recently, a team at Columbia University found that several of their patients had trouble resisting the urge to eat when taking Parkinson's medications, causing them to gain significant weight.

Treatment may be only part of the issue. Compared to 100 patients who used Parkinson's drugs without becoming addicted to them, those who abused their medications were more likely to be younger, drink alcohol, suffer from depression and exhibit more novelty-seeking traits to begin with, a new study from England found.

Attacking the Cause

So what should patients do? First off, experts say, is to recognize such problems exist. Although surgery and a variety of Parkinson's drugs have been linked to these side effects, the major culprit appears to be the so-called dopamine agonists, such as Requip and Mirapex, which are more potent than other medications. These drugs are favored by younger patients because they have a lower risk of long term complications than Sinemet, the mainstay of Parkinson's treatment.

Reducing the doses may help, but this raises the risk of uncontrolled tremors, says Menza. Dr. Daniel Weintraub, a professor of psychiatry and neurology at the University of Pennsylvania Medical School, says that the simple answer is to switch from a dopamine agonist to another medication.

For those who experience behavioral changes with treatment, various interventions are known to improve impulse control and fight addiction. Anti-psychotic medications can also help keep such troubling behavior in check. Ultimately, it's up to the patient to recognize that they are not acting like the person they've always been.

"When patients are taken off these drugs, they return to normal," says Weintraub.

Parkinson's drug linked to bizarre out-of-control urges

Sun, 01 Jan 2006 00:00:00 -0800

Faced with steady deterioration from Parkinson's disease, Jim Sweet leapt at the chance to try a new drug that promised to relieve the tremors brought on by the death of cells deep in his brain.

Like older Parkinson's medicines, Mirapex could bolster the fading supply of a critical brain chemical called dopamine. It was a blessing for Sweet until something unusual started happening.

First, he started buying things in eBay auctions a camera, a reclining leather chair, a big-screen TV, sunglasses, costume jewelry. He dived into online gambling, lottery tickets and penny stocks. Before long, he was disappearing for days to play slot machines near his home in Rancho Cucamonga, Calif.

He pawned his CD collection, his children's video game player and his wedding ring.

Gambling ''was something I could not turn off,'' said Sweet, a 45-year-old former middle school teacher.

Although Mirapex and similar dopamine drugs have helped thousands of Parkinson's patients, researchers are beginning to detect a small group for which the medicine seems to act like a jolt of electricity, triggering bizarre out-of-control urges.

MANY AFFECTED

According to a recent University of Toronto study, as many as one in 15 patients taking the drugs -- potentially thousands of people -- may have compulsive reactions.

An elderly California widower started wearing dresses, heels and lipstick; one man became obsessed with fast driving and abandoned his job to ride a Jet Ski up the California coast, according to a study by University of Southern California researchers.

People who claim their lives were shattered by their strange urges have filed lawsuits against drug makers. Although their compulsions disappeared after they stopped taking the drugs, some patients say they are still haunted by their experiences.

Sweet can only guess where his compulsion came from. He had barely been inside a casino before, although he remembered he and his wife once won $800 in Las Vegas. Thrilled, they bought an entertainment center for the family.

His life was happy until one day nine years ago when his left arm froze during a church league basketball game. Weeks later, his arm shook as he grasped the hand of a teammate to form a prayer circle.

They were the first signs of Parkinson's disease, which afflicts 500,000 to 1 million Americans, most of them elderly. Sweet was 38, the father of two young children.

Parkinson's is caused by the death of cells that produce dopamine, a neurotransmitter that carries messages along the brain's pathways. A shortage of the chemical causes poor coordination, shaking and bad balance. With time, symptoms include incontinence, difficulty talking and paralysis. There is no cure.

Sweet soon began taking the standard Parkinson's drug, levodopa, which is converted to dopamine in the brain.

The decades-old medicine carried some undesirable side effects, including involuntary tongue movements, grimacing and head bobbing. Sweet switched to Mirapex, marketed by German drug maker Boehringer Ingelheim.

The changes began in a matter of weeks, Sweet said.

MOUNTING DEBT

His wife, Kris, said she noticed him spending all his free time at the computer. For the first seven years of marriage, the couple never had a credit card balance. Now their debt was mounting from stock and online gambling losses.

''It was like being outside yourself, watching as you do these horrible things,'' he said. ``I was still Jim. I still cared. I was trapped inside my mind.''

Kris slept with her wallet under her pillow and hid her jewelry. ''I couldn't trust him,'' she said. ``I had to protect the family.''

At the University of California, Los Angeles, Dr. Jeff Bronstein, a neurologist, tried to rein in Jim's gambling with counseling and drugs. There was no improvement. Bronstein finally turned his attention to Jim's Parkinson's medication.

Around the United States, other doctors started noticing odd behaviors in their patients.

An August 2003 report in the journal Neurology linked the drugs to gambling in eight Arizona patients. Although the rate was the same as in the general population, the drug appeared to act as a trigger in patients, who stopped gambling when the medicine was discontinued.

Soon, a fuller picture emerged. At a meeting of the Movement Disorders Society in 2004, Dr. Jennifer Hui, a neurologist, and her colleagues at USC said patients' odd behaviors weren't limited to gambling.

What friends and families dismissed as quirky mid-life preoccupations or irresponsible behavior appeared to be drug-induced personality shifts, Hui said. She had patients who had become obsessed with golf, sex, home decoration and gardening.

The root of the phenomena, scientists suspect, relates to the complex role of dopamine in the brain. Not only does the chemical carry messages that convert thought to movement, but it also stimulates a part of the brain, the limbic region, that controls feelings of reward and well-being. Gambling, sex, addictive drugs and some habits, like playing video games, are known to stimulate the release of dopamine in the limbic region.

''Without dopamine we would never be addicted to cocaine, cigarettes, heroin or anything,'' said Northwestern University scientist D. James Surmeier.

Writing in Neurology last September, a team from the Mayo Clinic in Rochester, Minn., found that the dopamine drugs had a strong attraction to nerve cells found in large numbers in the limbic region and likely overstimulated the area.

Surmeier, a dopamine expert, called the link to cells in the limbic region ``a smoking gun.''

GAMBLING LINK

In February, a Food and Drug Administration study published in Neurology found a strong association between the drugs and pathological gambling, although the total number of complaints received by the agency was small.

Within the past year, the companies have added information about compulsive reactions to their package inserts. Boehringer Ingelheim said it was working with Parkinson's experts to investigate reports of pathological reactions.

For patients who need the drugs to manage the inexorable progression of Parkinson's, options are limited. Lowering drug doses seems to eliminate compulsions in some patients, doctors say. Other patients have channeled their obsessions into more productive behaviors.

Sweet, meanwhile, still can't completely forget the three years when gambling overwhelmed his life.

After doctors at UCLA took him off Mirapex, ''It was like a weight being lifted from my head,'' said Sweet, who recently settled a federal lawsuit against Boehringer Ingelheim and Pfizer Inc., which co-marketed Mirapex in the United States.

Studies and Lawsuits Point Accusing Fingers at the Parkinson's Drug, MIRAPEX, that Has Been Linked to Compulsive Gambling

Thu, 29 Dec 2005 00:00:00 -0800

It is admittedly an odd connection but there seems to be no real doubt that MIRAPEX, a drug used to treat Parkinson’s disease (PD), is also responsible for turning some of the patients who used it into gambling addicts.

In July, a Mayo Clinic study published in the Archives of Neurology that identified 11 Parkinson’s patients who developed a gambling habit while taking MIRAPEX or similar drugs between 2002 and 2004. Since the study was released, 14 additional Mayo patients have been diagnosed with the problem according to lead author Dr. M Leann Dodd, a psychiatrist at the Clinic.

Previously, in August 2003 in the journal Neurology, Drs. E. Driver-Dunckley, J. Samanta, and M. Stacey published an article entitled “Pathological gambling associated with dopamine agonist therapy in Parkinson’s disease.”

That study found extreme cases of compulsive gambling in nine (of 1,884) patients using pramipexole (8 or 1.5%)) and pergolide (1 or 0.3%). Both results were well above the overall incidence rate of all PD patients of 0.05%. Both drugs that showed an increased risk were dopamine agonists (DA).

The Mayo Clinic study also analyzed the findings in five prior studies (including the 2003 Driver-Dunckley study) and confirmed that: “All of the commonly prescribed dopamine agonists have been associated with pathological gambling” with pramipexole being “disproportionately represented in both our series (82% of our patients) and in prior reports (59%).”

MIRAPEX (pramipexole dihydrochloride) is in the dopamine agonist class of drugs and is believed to work by mimicking the action of dopamine in the brain to help control the symptoms of Parkinson’s disease. Dopamine also affects brain processes that control emotional responses and a person's ability to experience pleasure and pain. It is thought to play a role in addictive behavior.

Unfortunately, this is another drug whose benefits come with a very high price tag for some patients. The ones who become addicted to gambling often wind up losing their life savings, fall deeply into debt, and even jeopardize or destroy their marriages or other personal or family relationships.

In the past, the victims of this harsh side-effect had no idea what had come over them. Their brain was literally taken over and their gambling became constant and compulsive. Simply stated, they were out of control and had no idea why. For these people, the situation was frightening and inexplicable.

As a result of this completely bizarre and damaging side-effect, many MIRAPEX users suffered long periods of debilitating and destructive behavior during which they were unaware that the drug was causing the problem and that it would cease if they discontinued taking it.

MIRAPEX is manufactured by German-based Boehringer Ingelheim Pharmaceuticals, the world's biggest family-owned drug company, in cooperation with New York-based Pfizer, the world's largest drugmaker. Its sales for 2004 topped $200 million in the U.S. alone.
.Boehringer Ingelheim lists "compulsive behaviors (including sexual and pathological gambling)" as a possible side effect associated with taking MIRAPEX. That seven-word phrase on page 17 of a 21-page highly technical document is all the warning that is given concerning the potentially detrimental side-effect.

While Boehringer-Ingelheim has repeatedly claimed there is no scientific evidence upon which to base the conclusion that MIRAPEX causes addictive or compulsive behavior, the multiple reputable studies on the subject would seem to indicate otherwise. In addition, the company revised its package insert to include the warning with respect to “compulsive behavior” despite its denial of the connection.

Currently, two major lawsuits against Boehringer Ingelheim and Pfizer have been commenced in federal court in California and in Superior Court in Ontario, Canada. They allege a number of addictive behaviors associated with MIRAPEX including gambling, shopping, having sex, eating, and engaging in other compulsive conduct.

It is likely that additional lawsuits will be commenced in the near future since the problem is as widespread as the locations of people who took MIRAPEX.

Jerrold Parker, managing partner of Parker & Waichman, a law firm with considerable experience in pharmaceutical and medical malpractice litigation nationwide, told us that: “It is difficult to imagine how the manufacturers of MIRAPEX can maintain there is no scientific evidence to support the addiction link when several studies leave little doubt of the connection. In addition, it is rather amazing that when the manufacturers finally decided to add a warning regarding compulsive conduct to the product insert they chose to hide it in the middle of 21 pages of technical data.”

Popular Parkinson's drug linked to gambling

Tue, 12 Jul 2005 00:00:00 -0700

Joe Neglia was a retired government intelligence worker with Parkinson’s disease when he suddenly developed what he calls a gambling habit from hell.

After losing thousands of dollars playing slot machines near his California home several times a day for nearly two years, Neglia stumbled across an Internet report linking a popular Parkinson’s drug he used with compulsive gambling.

“I thought, 'Oh my God, this must be it,”’ he said. Three days after stopping the drug, Mirapex, “all desire to gamble just went away completely. I felt like I had my brain back.”

A Mayo Clinic study published Monday in July’s Archives of Neurology describes 11 other Parkinson’s patients who developed the unusual problem while taking Mirapex or similar drugs between 2002 and 2004. Doctors have since identified 14 additional Mayo patients with the problem, said lead author Dr. M. Leann Dodd, a Mayo psychiatrist.

“It’s certainly enough for us to be cautious as we are using it,” Dodd said. “We wouldn’t want them to have some kind of financial ruin or difficulties that could be prevented.”

Compulsive gambling, sex and shopping

Dr. Leo Verhagen, a Parkinson’s specialist at Chicago’s Rush University Medical Center who was not involved in the study, says he and some colleagues all have a few patients who developed compulsive gambling while taking Mirapex, a drug that relieves tremors and stiffness. The behavior usually disappears when the drug dose is lowered, Verhagen said. He praised the Mayo article for raising awareness for doctors and patients.

Neglia, 54, now living in Millersville, Md., was not treated at Mayo or involved in the study. He said the problem is underreported “because of the embarrassment factor” and is one of several patients suing manufacturer Boehringer-Ingelheim Pharmaceuticals Inc., accusing the company of failing to adequately warn patients about the potential side effects.

AN attorney, who filed the lawsuit last year, said he’s spoken with more than 200 Mirapex patients who developed compulsive behaviors, including excessive gambling, sex and shopping. He is seeking to have the complaint certified as a nationwide class-action lawsuit. A similar suit has been filed in Canada, the attorney said.

Neglia said he has contacted the Food and Drug Administration but that the agency has failed to act on numerous adverse reaction reports about Mirapex. An FDA spokeswoman said the agency is examining the reports to determine if there’s any connection to the drug but declined to say how many it has received.

Katherine King O’Connor, a spokeswoman for the Ridgefield, Conn.-based Boehringer-Ingelheim Pharmaceuticals, said there’s no scientific evidence that Mirapex causes the problem. Still, the company revised Mirapex’s package insert earlier this year to include compulsive behavior among potential side effects after receiving “rare” reports all after the drug was approved for U.S. use in 1997, O’Connor said.

'Like a light switch being turned off'

Mirapex was among top-selling Parkinson’s drugs last year, with more than $200 million in U.S. sales, according to IMS Health, a pharmaceutical information and consulting firm.

Mirapex, or pramipexole, reduces tremors and the slow, stiff movements that are a hallmark of Parkinson’s disease. It belongs to a class of drugs that mimic the effects of dopamine, a brain chemical that controls movement and is deficient in Parkinson’s disease.

Mirapex targets dopamine receptors in a brain region associated with emotions that include pleasure and reward-seeking behavior, Dodd said. It can also cause extreme sudden sleepiness.

It is sometimes used alone or with the mainstay Parkinson’s drug, levodopa.

Though a few of the Mayo patients took related drugs, Dodd said most used Mirapex. They included a 68-year-old man who lost more than $200,000 at casinos over six months and a 41-year-old computer programmer who became “consumed” with Internet gambling, losing $5,000 within a few months.

Dodd said Mayo doctors now ask patients using the drugs if they have suddenly taken up gambling. Affected patients are usually switched to different drugs or doses, and the result is often dramatic, “like a light switch being turned off when they stopped the drug,” she said.

Mirapex Gambling Lawyer Compulsive Behavior Side Effects Attorney

Tue, 12 Jul 2005 00:00:00 -0700

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Mirapex Side Effect Lawyers

The lawyers and attorneys at our firm are offering free case evaluations to victims of Mirapex side effects. Mirapex, which is used to treat Parkinson’s Disease and restless leg syndrome, has been associated with compulsive behavior, including gambling addiction. If you or someone you know developed a gambling addiction or some other compulsive behavior after starting treatment with this drug, we urge you to contact one of our Mirapex side effect lawyers as soon as possible to protect your legal rights.

Mirapex was approved by the FDA in 1997 and by the end of 2004 accounted for almost 18 percent of prescriptions written to treat Parkinson's disease. Since its approval, hundreds of Mirapex users have claimed that they developed compulsive behaviors. In addition to gambling addictions, people treated with Mirapex have suffered from various impulse control disorders such as compulsive shopping, sexual addictions and eating disorders.

In virtually every alleged case, the victims of Mirapex side effects had no prior history of obsessive or compulsive behaviors. And in most cases, the compulsive behavior subsides once Mirapex is discontinued. The maker of Mirapex has denied that there is an association between these behaviors and this medication, but our Mirapex side effect lawyers are aware of numerous studies that show otherwise.

Parkinson's Disease occurs because of a lack of the neurotransmitter dopamine in certain areas of the brain. Mirapex is a dopamine agonist and works by mimicking the effects of this chemical. As such, dopamine helps people control their movements and increases feelings of happiness and satisfaction. However, dopamine is also known to produce a “rush” in the brain of people who are anticipating a reward or excitement. Many experts believe that such a biochemical reaction is behind the reports of compulsive behavior linked to Mirapex.

It is known that Boehringer Ingelheim and Pfizer received reports linking the drug to compulsive behavior during clinical trials conducted in the 1990s, and received additional reports of patients developing gambling addictions after it came on the market. But it wasn’t until 2005 - eight years after its introduction - that information about compulsive behavior was finally added to the Mirapex label. The companies’ delay in warning patients about the dangers posed by this drug resulted in many ruined lives. The Mirapex side effect lawyers at our firm are committed to making sure Pfizer and Boehringer Ingelheim are held accountable for this negligence.

Studies Link Mirapex to Gambling Addiction, Compulsive Behavior

Despite a growing mountain of evidence linking this drug to various impulse control disorders, the makers of Mirapex have refused to acknowledge its link to gambling addiction and other problems. However, our Mirapex side effect lawyers are aware of several studies that do in fact show a connection. These studies prove that Mirapex can cause neurological changes that put patients at risk for gambling addictions and other compulsive behaviors.

One of the first studies that linked gambling addiction to Mirapex was published in a 2003 issue of the journal Neurology. Researchers at the Muhammad Ali Parkinson Research Center at the Barrow Neurological Institute in Arizona monitored 1,800 Parkinson's patients over a one year period and determined that of the 529 patients in the study who took Mirapex, eight developed gambling addictions. For most patients, the gambling behavior improved after they stopped taking Mirapex.

In a July 2005 Mayo Clinic researchers reported in the Archives of Neurology more documented behavior that supported earlier observations linking dopamine agonist drugs with gambling addiction and compulsive behaviors. The report detailed 11 Parkinson's patients who developed gambling problems while taking Mirapex or similar drugs between 2002 and 2004. After the study’s completion, the Mayo clinic researchers identified 14 additional patients with the problem.

In June 2008, results from the largest study ever to investigate the connection between compulsive behavior and dopamine agonists like Mirapex was presented at the at the International Congress of Parkinson’s Disease and Movement Disorders conference in Chicago. The study looked at more than 3,000 patients from 46 medical centers in the United States and Canada, and found that Parkinson’s patients on these medications were nearly three times more likely to have at least one impulse-control disorder compared with patients receiving other treatments. The study found that more than 13 percent of patients taking dopamine agonists suffered from at least one of four serious behavioral addictions.

The 2008 dopamine agonist study raised serious concerns in the medical community. Dr. Eric Ahlskog, a neurologist at the Mayo Clinic who has treated Parkinson’s patients for 25 years, told The Chicago Tribune that he no longer is comfortable starting patients on dopamine agonists after three patients in his practice developed significant gambling and sexual problems. Other doctors told the Tribune that while they still treat patients with dopamine agonists, they are using smaller doses. Many are also now asking the patients they treat with the drugs and their families about compulsive behaviors as part of routine patient checkups.

Mirapex Lawsuits

The impulse control problems experienced by Mirapex users have resulted in bankruptcies, broken marriages, depression and even suicide. As a result, many have filed lawsuits against Pfizer and Boehringer Ingelheim in an attempt to hold these companies accountable for marketing a dangerous drug, and to regain some sense of control over their lives. Currently, more than 300 such lawsuits are scheduled to go to trail in the Mirapex multidistrict litigation in the US District Court in Minneapolis.

In the summer of 2008, the first verdict was reached in one of these Mirapex lawsuits. This lawsuit was considered a “bellwether” case, in that lawyers believed they could gauge the prospects of other Mirapex claims by the success or failure of this initial lawsuit. A verdict was reached in the case in August 2008, with the jury awarding the plaintiff $8.2 million.

The plaintiff in the lawsuit was typical of many Mirapex victims. He began taking Mirapex in December 1997, and suffered from a gambling addiction from March 2002 to February 2006. In that period of time, he gambled away $260,000. The plaintiff not only claimed that Mirapex caused his gambling problem, but that the drug’s makers, Pfizer and Boehringer Ingelheim, knew about its potential to cause compulsive behavior, but did not issue any warnings, or take steps to investigate the true scope of the problem. The federal jury agreed with the plaintiff, and awarded him all of his gambling losses, along with $7.8 million in punitive damages.

In light of this case, the prospects that other Mirapex lawsuits will be decided in favor of plaintiffs are extremely good. The Mirapex side effects lawyers at our firm have been able to achieve excellent results for victims of other defective drugs, and we are committed to making sure those whose lives have been impacted by Mirapex impulse control disorders receive the compensation they deserve.

Help for Mirapex Side Effect Victims

If you or someone you love developed a gambling addiction or some other compulsive behavior after starting treatment with Mirapex, you have valuable legal rights. Please fill out our online form, or call 1-800 LAW INFO (1-800-529-4636) to speak with an experienced Mirapex side effects lawyer at our firm.