Psychotic symptoms following sildenafil and panax ginseng treatment in a pramipexole induced manic patient with Parkinson's Disease: a case report

Abstract

Objective: Parkinson’s disease (PD) is a chronic neurodegenerative disease characterized by movement abnormalities. It is well known that dopamine agonists are associated with several psychiatric symptoms during the treatment of PD. Pramipexole with a great affinity for D3 receptors, particularly on mesolimbic regions may induce manic or psychotic symptoms by stimulating mesolimbic dopaminergic neurons, as well as the other dopaminergic agonists. Panax Ginseng is a herbal drug which also contains sildenafil and acts through central cholinergic and dopaminergic mechanisms. Sildenafil is a widely used drug for the treatment of erectile dysfunction and predominantly inhibits the breakdown of PDE5 and thus increases the amount of cGMP. Comorbid psychiatric symptoms should be taken into consideration when different classes of drugs were used during the treatment of PD. Methods: We here report on a male patient who first developed mania while receiving pramipexole, and some additional pscyhotic symptoms further emerged when panax ginseng and sildenafil were added to the ongoing pramipexole treatment because of erectile dysfunctions. Results: A patient with PD was admitted to psychiatry unit with some psychotic symptoms after taking sildenafil and panax ginseng for erectile dysfunction in combination with pramipexole. Conclusion: This case demonstrated that some drugs which were not primarily used in the treatment of PD, might have caused some severe psychotic symptoms due to underlying pschopathology of PD, drug interaction, and the action of mechanisms of the dopaminergic drugs.