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so as I put in a different post, the reason my gyno/endo NP was unwilling to prescribe bromacraptine or capergaline without permission of my pdoc was because a possible serotonin syndrome flag popped up in contrast with thel lithium.  It seems like a  bit of a stretch for me, but good to know.  It's a level C interaction.

My pdoc was willing to prescribe and monitor for SS  But what am I monitoring for?  It's one of the few bad side effects that iI haven't had before (EPS I’m looking at you).

now I’m worried.

Edited by dancesintherain
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Symptoms:

https://www.drugs.com/mcd/serotonin-syndrome

caution is never a bad thing, but I’m not sure that means you have to be worrying all the time. YMMV but I’ve never had an issue with lith + any other med for serotonin syndrome and it’s pretty rare (although clearly I won’t be on your med cocktail) Obviously, I don’t want to speak for your pdoc or say that it could never happen, just that i wouldn’t freak out. If your pdoc was overly worried they wouldn’t have Rx’d the med.

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The danger lies mostly in the supposed serotonin releasing properties of lithium and the agonism (stimulation) of 5-HT2A receptors of these two dopamine agonists, but the ratio of agonism of 5-HT2A receptors to any of the dopamine receptors bromocriptine in particular stimulates should not really be of any concern... Cabergoline is a little different. Its stimulation of 5-HT2A is pretty close in binding potency to the stimulation of dopamine receptors, and in high doses, 5-HT2B stimulation becomes a huge concern which can cause very serious cardiovascular side effects.

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12 minutes ago, dancesintherain said:

Thanks—so does that make cabergoline a riskier option or are they similar to not make a difference?

Cabergoline, when dosed for hyperprolactinemia, which I assume is close to the same if not higher than doses used for sexual dysfunction, is relatively safe. It is only taken a few times a week rather than being a daily med. I think I read that 30% of patients on cabergoline will experience some sort of cardiovascular symptom, most commonly hypotension (I think).

Bromocriptine supposedly has more side effects and requires a slower taper, and is less potent at dopamine receptors, but is probably safer in some regards than cabergoline. Cabergoline is newer and isn't as well-researched as bromocriptine.

I guess what I'm trying to say is it's a crap shoot, and you could try either one first. My guess is that cabergoline is probably more effective for sexual dysfunction as it is used in male pornography stars to reduce or eliminate the refractory period, enabling them to have several orgasms one after the other in short periods of time.

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Well “there’s no good answer” is still an answer.  The cabergoline is supposed to be on tuesdays and Fridays and I’m taking half a pill. And I stay that before checking my prolactin levels in two months.  So my NP and pdoc plan to move slowly.

thanks for the feedback!

Edited by dancesintherain
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