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Opioid Antagonist Naltrexone for the Treatment of Pathological Gambling in Parkinson Disease

Bosco, Domenico MD*; Plastino, Massimiliano MD*; Colica, Carmela PhD; Bosco, Francesca PhD; Arianna, Spanò PhD; Vecchio, Antonino MD§; Galati, Francesco MD§; Cristiano, Dario MD*; Consoli, Arturo MD; Consoli, Domenico MD§

doi: 10.1097/WNF.0b013e31824d529b
Original Articles

Pathological gambling (PG) is a potential complication related to the treatment of Parkinson disease (PD) with dopamine agonists (DA). The cause of this disorder is unknown, but altered dopamine neurotransmission may be involved.

Objective We evaluated the efficacy and tolerability of the opioid antagonist naltrexone in the treatment of PG in PD.

Methods Our cases included 3 patients with PD who developed PG after DA treatment.

Results Pathological gambling did not improve after reduction or discontinuation of DA. These patients responded poorly to serotonin reuptake inhibitors, whereas treatment with opioid antagonist naltrexone resulted in the remission of PG. Naltrexone treatment was well tolerated. In one patient, higher dose of naltrexone resulted in hepatic abnormalities, which resolved after dosage reduction.

Conclusions The opioid antagonist naltrexone could be an effective option for the treatment of PG in PD.

*Department of Neurology, “S. Giovanni di Dio,” Crotone; †Neurological Science Institute–Council Research Centre; ‡Department of Pharmacology, University “Magna Graecia”, Catanzaro; §Department of Neuroscience, “G. Jazzolino” Hospital, Vibo Valentia; and ∥Department of Radiology, “Careggi” University, Florence, Italy.

Conflicts of Interest and Source of Funding: The authors have no conflicts of interest to declare.

Address correspondence and reprint requests to Domenico Bosco, MD, Department of Neurology, “S. Giovanni di Dio”, Via Largo Bologna, 88900 Crotone, Italy; E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.