Naltrexone Use in Treating Hypersexuality Induced by Dopamine Replacement Therapy: Impact of OPRM1 A/G Polymorphism on Its Effectiveness.

Audrey Verholleman,Edouard Laforgue,Celine Verstuyft,Caroline Victorri-Vigneau,Pascal Derkinderen,Marie Grall-Bronnec

doi:10.3390/ijms21083002

Abstract

Hypersexuality is a well-known adverse side effect of dopamine replacement therapy (DRT), and anti-craving drugs could be an effective therapeutic option. Our aim was to update the knowledge on this issue, particularly on the influence of an Opioid Receptor Mu 1 (OPRM1) genetic polymorphism. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We also analyzed a case of iatrogenic hypersexuality that occurred in a patient treated with DRT. An analysis of the OPRM1 gene was performed on said patient. Our search identified 597 publications, of which only 7 were included in the final data synthesis. All seven publications involved naltrexone use. Five of them were case reports. None of the publications mentioned DRT side effects, nor did they report genetic data. Regarding our case report, the introduction of naltrexone corresponded with the resolution of the patient’s hypersexuality. Moreover, the patient carried the A/G genotype, which has been reported to be associated with a stronger response to naltrexone for patients with an alcohol use disorder. Although studies are inconclusive so far, naltrexone could be an interesting therapeutic option for resistant hypersexuality due to DRT. Carrying the A/G genotype could help explain a good response to treatment.

Highlights

Impulse control disorders (ICDs) are frequently found in patients treated for Parkinson’s disease (PD), and are known to be a relatively frequent side effect of dopamine replacement therapy (DRT) [1,2]
Our systematic review showed that only a few articles were available about the potential use of opioid antagonists in treating hypersexuality symptoms, even in the general population, and most of these were case reports
Our case report is consistent with the available literature data and useful to strengthen the hypothesis of naltrexone effectiveness

Summary

Introduction

Impulse control disorders (ICDs) are frequently found in patients treated for Parkinson’s disease (PD), and are known to be a relatively frequent side effect of dopamine replacement therapy (DRT) [1,2]. ICDs include different impulsive behaviors, such as pathological gambling, hypersexuality, binge eating, or compulsive shopping [3,4,5] They share symptoms found in the field of addiction, the failure to reduce or control a behavior despite impaired daily functioning and the resulting negative impact on one’s quality of life [1,6]. Bosco et al [12] published three case reports of PD patients with pathological gambling who responded to naltrexone, with resolution of symptoms for all three of them The effectiveness of these drugs in alcohol use disorders seems to be linked to a genetic polymorphism of the Mu opioid (Mu) receptor (MOR), A118G, this is still debated [14,15,16]. To the best of our knowledge, only one publication (written in Dutch and not included in our study) has described the effectiveness of naltrexone in a PD patient with DRT-induced hypersexuality [24]

Objectives

Methods

Results

Conclusion