Piribedil-induced sleep attacks in patients without Parkinson disease: a case series

Sleep attacks were initially described in 1999 in patients with Parkinson disease (PD) treated by dopamine agonists (DAs). Because the respective role of DAs or PD-induced excessive daytime sleepiness is still unclear, reports of sleep attacks in non-PD patients treated with DA would support the specific role of these drugs. Piribedil, a nonergot dopamine D2/D3 agonist with alpha(2)-noradrenergic properties, is indicated in the treatment of PD as well as in patients with circulatory disorders. After a spontaneous report of sleep attack associated with piribedil use in a non-PD patient, we reviewed other cases from the French pharmacovigilance database.

Cases of piribedil associated with sleep attacks recorded between 1988 and December 2008 were identified in the French Pharmacovigilance database. Cases were retained for analysis only if patients were treated for conditions other than PD.

Overall, a total of 35 cases of piribedil-induced sleep disorders were retrieved, and 7 cases suggestive of sleep attacks were retained for analysis. The mean time to onset after starting piribedil was 2.5 days. Piribedil was the only suspected drug in all but 1 patient. Complete recovery was noticed after piribedil discontinuation in all patients, and recurrence of symptoms was observed after piribedil reintroduction in 1 patient.

Our series suggests that piribedil may be associated with sleep attack disorders independently of the treated disease and supports the prominent role of DAs in sleep disorders.