Pramipexol, Covid-19 en/of bariatrische heelkunde: place your bets

Abstract

Pramipexole, COVID-19 and/or bariatric surgery: place your bets A 56-year-old woman was diagnosed with restless legs syndrome (RLS). Initially, a magnesium supplement was started, which did not improve her situation. Neither did the subsequent pregabalin, although alpha-delta ligands are currently the treatment of first choice. The start-up of a trial treatment with pramipexole in a next step had an immediate positive effect on the complaints. Dopamine agonists are, however, no longer the first-choice treatment for RLS, although they may be used as a therapy for this condition in case of insufficient effect of the initial treatment or in the presence of a contraindication. Four months after the start-up of pramipexole, a problem of pathological gambling was identified in the patient. Since the gambling had started during the COVID-19 pandemic and the patient was known with bariatric surgery in the past, the relationships between these 2 factors and the possible development of a gambling addiction were also investigated using literature. An increase in gambling activities as a result of the COVID-19 pandemic or as a postoperative complication of a gastric bypass could not be demonstrated. The intake of pramipexole was the most likely cause of the impulse control disorder in this patient. Physicians prescribing pramipexole, also in low doses, should monitor their patients regularly regarding the development of such a disorder as a possible side effect. A gradual phase-out with discontinuation of the treatment should be considered in case of an impulse control disorder.