Dopamine Agonists & Stimulants

Tapering Guidance

If used daily for more than 3-4 weeks

• A reasonable starting point is to reduce dose by 20-25% every week (i.e. week 1- 75-80% of dose). Depending on response, this can be extended or decreased (10% dose reductions) if needed.
• If intolerable withdrawal symptoms occur (usually 1-3 days after a dose change), go back to the previously tolerated dose until symptoms resolve and plan for a more gradual taper with the patient.
• Dose reduction may need to slow down as one gets to smaller doses (i.e. when 25% of the original dose is reached).
• Overall, the rate of discontinuation needs to be controlled by the person taking the medication and their discontinuation symptoms.

Withdrawal Symptoms and Monitoring Guidance

• Inital: Flu-like symptoms, yawning, insomnia, anxiety, panic attacks, dysphoria, depression, agitation, irritability, suicidal ideation, fatigue, orthostatic hypotension, nausea, vomiting, diaphoresis, generalized pain, and drug cravings.
• Protracted: primarily feature dysthymia, complaints of depression, anxiety, and stress intolerance, anxiety, panic attacks, irritability

Additional Information

Dopamine agonists are used for Parkinson’s Disease, restless legs syndrome and other indications. There are some suggestions that anyone with impulse control disorders (ICDs) or compulsive behaviors (punding) while on treatment are more likely to develop withdrawal syndromes. At least 15% of takers develop clear ICDs.  The stimulants are a closely related group of drugs used for cognitive enhancing purposes and for attention deficit hyperactivity disorders (ADHD). The group of drugs include delayed-release and immediate-release version of methylphenidate and dexamphetamine. Dopamine Agonist Withdrawal syndrome (DAWS) occurs in up to 20% of users and makes it clear that all these groups can cause problems.