dancesintherain Posted February 19, 2020 Share Posted February 19, 2020 (edited) 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 February 19, 2020 by dancesintherain Link to comment Share on other sites More sharing options...
Iceberg Posted February 19, 2020 Share Posted February 19, 2020 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. Link to comment Share on other sites More sharing options...
dancesintherain Posted February 19, 2020 Author Share Posted February 19, 2020 Thanks Iceberg, that helps a lot. Thinking about it, I took lithium with an actual SSRI (Luvox). I know drugs interest in interesting way, but I’ll try not to freak out. Link to comment Share on other sites More sharing options...
Iceberg Posted February 19, 2020 Share Posted February 19, 2020 I had a pdoc whose mainstay was high dose lithium and an SSRI for BP depression, it’s certainly Not super uncommon Link to comment Share on other sites More sharing options...
mikl_pls Posted February 19, 2020 Share Posted February 19, 2020 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. Link to comment Share on other sites More sharing options...
dancesintherain Posted February 19, 2020 Author Share Posted February 19, 2020 Thanks—so does that make cabergoline a riskier option or are they similar to not make a difference? Link to comment Share on other sites More sharing options...
mikl_pls Posted February 19, 2020 Share Posted February 19, 2020 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. Link to comment Share on other sites More sharing options...
dancesintherain Posted February 19, 2020 Author Share Posted February 19, 2020 (edited) 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 February 19, 2020 by dancesintherain Link to comment Share on other sites More sharing options...
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