Abstract
BACKGROUND: The dopaminergic system plays a central role in motor control, goal-directed behavior, and the pathophysiology of multiple diseases including restless legs syndrome. Dopamine agonists such as pramipexole are commonly prescribed for the treatment of restless legs syndrome; however, growing recognition of potential serious adverse effects has led to updated clinical guidelines which now recommend against the routine use of dopamine agonists as initial therapy. CASE PRESENTATION: We present the case of a 64-year-old woman with severe restless legs syndrome and medically unexplained chronic pain who was psychiatrically hospitalized for active suicidal ideation. During her admission, it was discovered that a supratherapeutic dose of pramipexole was the source of iatrogenic harm. Her condition improved following medication taper, appropriate management of restless legs syndrome, and acute psychiatric interventions. CONCLUSION: Clinicians should be aware of the potential adverse effects associated with dopamine agonists and adhere to updated recommendations for the management of restless legs syndrome.