Dopamine Agonist Withdrawal Syndrome

Reducing or discontinuing dopamine agonist medications can be complex and should usually be undertaken gradually and under medical supervision.

Many patients experience significant improvement in impulse control disorders and other behavioural side effects after reducing or stopping dopamine agonist treatment. However, recovery is not always immediate and some behaviours or consequences may persist after the medication has been discontinued. Published evidence suggests this may be more likely in people exposed to higher doses, longer treatment durations, or those who have experienced severe impulse control disorders or dopamine dysregulation syndrome (DDS).

For some individuals, stopping dopamine agonists can also be accompanied by withdrawal symptoms, known as Dopamine Agonist Withdrawal Syndrome (DAWS). DAWS is a reaction that can occur when dopamine agonist medications are reduced, tapered or discontinued.

Sympthoms may include:

  • Anxiety and panic attacks

  • Depression

  • Agitation

  • Fatigue

  • Pain

  • Nausea

  • Excessive sweating (diaphoresis)

  • Orthostatic hypotension

DAWS is most commonly recognised in Parkinson’s disease, although it has also increasingly been reported in people treated for Restless Legs Syndrome. Published studies in Parkinson’s disease suggest DAWS may affect around 15–25% of patients attempting to reduce or discontinue dopamine agonists, with higher risks reported among people taking higher doses or those who have developed impulse control disorders or dopamine dysregulation syndrome, although these conditions are not required for DAWS to occur. Gradual tapering under medical supervision may help reduce the risk and severity of withdrawal symptoms.

Important note

Awareness and recognition of dopamine agonist withdrawal syndrome (DAWS) remains low amongst many healthcare professionals. Because DAWS is still relatively under-recognised and its symptoms can overlap with other physical and psychological conditions, some patients report difficulties obtaining timely diagnosis, recognition or support.

DAWS is a real and potentially serious condition that deserves appropriate clinical recognition, support and management. If you are experiencing symptoms that you believe may be related to dopamine agonist withdrawal, discuss your concerns with an appropriately qualified healthcare professional. If necessary, consider seeking a second opinion, particularly from a clinician with experience of dopamine agonist medications and withdrawal.