Impulse control and correlation to dopamine agonist serum concentrations in people with Parkinson's disease.

Sara C Staubo, Ingeborg H Lie, Kirsti M J Alvik, Pål Jostad, Stein H Tingvoll, Kristina Rosqvist, Mathias Toft, Erik Sveberg Dietrichs, Per Odin, Hallvard Lilleng, Ole Martin Fuskevåg, Elisabet Størset, Espen Dietrichs

Journal: Journal of neurology 2025;272(2):134

PMID: 39812843

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Abstract

BACKGROUND

Impaired impulse control is often seen in Parkinson's disease (PD) patients using dopamine agonists.

METHODS

We performed a therapeutic drug monitoring study of 100 PD patients using ropinirole or pramipexole extended release. Three blood samples were collected on the same day. Serum concentrations were measured, and 24 h area under the curve (AUC) calculated. The validated Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) was used for assessing impulse control.

RESULTS

Total ropinirole drug exposure showed weak, but significant correlation to the QUIP-RS score. No correlation between pramipexole serum concentrations and QUIP-RS was found. In ropinirole patients, both agonist dose and total dopaminergic treatment were correlated with QUIP-RS. Duration of ropinirole treatment correlated with impaired impulse control, and duration of dopaminergic treatment of any type correlated with QUIP-RS scores in both ropinirole and pramipexole patients.

CONCLUSIONS

Our main finding is that impaired impulse control is correlated to both total drug exposure (AUC) and dopamine agonist dose for ropinirole, but not for pramipexole. These observations indicate that different strategies may be useful for treating PD patients with impaired impulse control: ropinirole dose reduction could be beneficial, whereas pramipexole treatment may have to be stopped.

Address: Department of Neurology, Oslo University Hospital, Rikshospitalet, Nydalen, PO Box 4950, N-0424, Oslo, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Department of Neurology, Akershus University Hospital, Nordbyhagen, Norway.; Experimental and Clinical Pharmacology, Institute of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway.; Department of Laboratory Medicine, Division of Diagnostic Services, University Hospital of Northern Norway, Tromsø, Norway.; Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.; Department of Neurology, Oslo University Hospital, Rikshospitalet, Nydalen, PO Box 4950, N-0424, Oslo, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Unicare Fram Rehabilitation Centre, Rykkinn, Norway.; Ringen Rehabilitation Centre, Moelv, Norway.; Department of Neurology, University Hospital of Northern Norway, Tromsø, Norway.; Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.; Division of Neurology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.; Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.; Department of Neurology, Oslo University Hospital, Rikshospitalet, Nydalen, PO Box 4950, N-0424, Oslo, Norway. [email protected].; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. [email protected].; Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.; Institute of Oral Biology, University of Oslo, Oslo, Norway.; Experimental and Clinical Pharmacology, Institute of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway.; Department of Laboratory Medicine, Division of Diagnostic Services, University Hospital of Northern Norway, Tromsø, Norway.

DOI: 10.1007/s00415-024-12870-8

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MeSH Terms: Humans, Parkinson Disease, Dopamine Agonists, Male, Female, Pramipexole, Benzothiazoles, Middle Aged, Aged, Indoles, Disruptive, Impulse Control, and Conduct Disorders, Antiparkinson Agents, Drug Monitoring, Area Under Curve, Dose-Response Relationship, Drug