Q. I take pramipexole to treat restless leg syndrome. When I play casino games, I seem not to be able to stop playing. I have almost maxed out my credit cards.

My doctor said a drug I was taking could cause an addiction, but I really couldn’t believe it would happen to me. I have also gained weight, which has caused stress with my wife.

I would never have believed I could have a gambling issue. The restless leg syndrome is under control, but I play casino games on my phone until I run out of money. I never had this problem before.

A. Most people find it hard to believe that a medication could lead to excessive gambling. However, neuroscientists have long recognized that drugs affecting the brain chemical dopamine may predispose some individuals to compulsive behavior. In this category, ropinirole (Requip) and pramipexole (Mirapex) are both prescribed for restless leg syndrome as well as Parkinson’s disease.

One study introduced the topic this way: “Problematic gambling has been suggested to be a possible consequence of dopaminergic medications used mainly in neurological conditions, i.e. pramipexole and ropinirole, and possibly by one antipsychotic compound, aripiprazole.” (Pharmaceutical Medicine, Jan. 7, 2023).

When doctors consult the official prescribing information for pramipexole, they read: “Cases of pathological gambling, hypersexuality, and compulsive eating (including binge eating), and compulsive shopping have been reported in patients treated with dopamine agonist therapy, including pramipexole therapy.” They should warn their patients, as your doctor did, that such medicines could have behavioral side effects.

Q. I am confused about vitamin D. I have been taking it for years, along with calcium, to protect my bones.

Recently, I read that there is no evidence it works and that too much could be harmful. Can you help me understand how much is enough and how much is too much?

A. A study in the New England Journal of Medicine (July 28, 2022) revealed that middle-aged people taking supplements of vitamin D3 (2,000 IU daily) did not have a lower likelihood of fractures in a randomized clinical trial lasting more than five years. Likewise, an independent Cochrane review did not find evidence that vitamin D with or without calcium could improve bone mineral density (Cochrane Database of Systematic Reviews, Jan. 27, 2023).

Vitamin D supplements may have other benefits, however. To learn more about the pros and cons of vitamin D, as well as how to determine the correct dose, you may wish to consult our “eGuide to Vitamin D and Optimal Health.” This online reference may be found under the Health eGuides tab at www.PeoplesPharmacy.com.

Q. I have read in your column that long-term use of proton pump inhibitors for reflux can cause a bunch of serious health problems. My doctor said that was fearmongering and not to worry. What is the story on PPIs?

A. PPIs such as esomeprazole (Nexium), lansoprazole (Prevacid) and omeprazole (Prilosec) have been extremely popular for decades to heal ulcers and control heartburn. Long-term use, however, may contribute to chronic kidney disease (Cureus, Jan. 24, 2026). Other complications can include low calcium and magnesium levels. Such mineral imbalances might increase the chance of drug-induced osteoporosis (Journal of Clinical Medicine, Jan. 26, 2026).

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 300 W. 57th Street, 41st Floor, New York, NY 10019, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”