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Risk of Gambling Disorder and Impulse Control Disorder With Aripiprazole, Pramipexole, and Ropinirole

A Pharmacoepidemiologic Study

Etminan, Mahyar PharmD, MSc; Sodhi, Mohit BSc; Samii, Ali MD; Procyshyn, Ric M. PharmD, PhD; Guo, Michael BSc; Carleton, Bruce C. PharmD

Journal of Clinical Psychopharmacology: February 2017 - Volume 37 - Issue 1 - p 102–104
doi: 10.1097/JCP.0000000000000634
Brief Reports

Background Recently, the US Food and Drug Administration issued a warning regarding the potential risk of gambling disorder, but large epidemiologic studies are lacking.

Methods We used a large health claims database from the United States and conducted a nested case-control study. Cases were defined as subjects newly diagnosed with gambling disorder or impulse control disorder. For each case, 10 controls were selected and matched to cases by age and follow-up time and calendar time. Adjusted rate ratios were computed with conditional logistic regression.

Results There are 355 cases of gambling disorder and 3550 controls along with 4341 cases of impulse control disorder and 43,410 corresponding controls. After adjusting for confounders, users of aripiprazole demonstrated an increased risk of pathologic gambling (rate ratio [RR], 5.23; 95% confidence interval [CI], 1.78–15.38) and impulse control disorder (RR, 7.71; 95% CI, 5.81–10.34). The risk was also elevated for pramipexole or ropinirole for both gambling disorder and impulse control disorder (RR, 7.61; 95% CI, 2.75–21.07; RR, 3.28; 95% CI, 2.31–4.66, respectively).

Conclusions Our study confirms an association between aripiprazole, pramipexole, or ropinirole and impulse control disorder and gambling disorder.

From the Departments of *Ophthalmology and Visual Sciences, and †Psychology, University of British Columbia, Vancouver, British Columbia, Canada; ‡Department of Neurology, University of Washington, Seattle, WA; §Department of Psychiatry, ∥Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, and ¶Child & Family Research Institute, University of British Columbia; and #Pharmaceutical Outcomes Programme, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.

Received June 18, 2016; accepted after revision October 28, 2016.

Reprints: Mahyar Etminan, PharmD, MSc, Department of Ophthalmology and Visual Sciences, University of British Columbia, The Eye Care Center Room 323–2550, Willow St, Vancouver, British Columbia, V5Z 3N9 (e-mail:

The study was funded by the Therapeutic Evaluation Unit of the British Columbia Provincial Health Services Authority.

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