From the Guidelines
The risk of developing serotonin syndrome when taking cabergoline and sertraline together is generally low, but it remains a theoretical concern that requires monitoring. Cabergoline primarily affects dopamine receptors rather than serotonin, which reduces the likelihood of a dangerous interaction with sertraline, a selective serotonin reuptake inhibitor (SSRI) 1. However, cabergoline does have some activity at certain serotonin receptors, which creates the potential for additive serotonergic effects when combined with an SSRI. According to the guideline, serotonin syndrome is a potentially serious complication most often associated with simultaneous use of multiple serotonergic drugs, and common symptoms include clonus, tremor, hyperreflexia, agitation, mental status changes, diaphoresis, and fever 1.
Some key points to consider when taking this combination include:
- Patients should be aware of serotonin syndrome symptoms, including confusion, agitation, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, tremor, excessive sweating, diarrhea, and fever.
- These medications can generally be used together with appropriate medical supervision, but any new or concerning symptoms should prompt immediate medical attention.
- Dosage adjustments may be necessary, and the combination should be avoided in patients with a history of serotonin syndrome or those taking other serotonergic medications that could further increase the risk.
- Treatment with SSRIs, such as sertraline, should be avoided in men with a history of bipolar depression due to the risk of mania 1.
- Patients should be advised to avoid sudden cessation or rapid dose reduction of daily dosed SSRIs, as this may precipitate SSRI withdrawal syndrome 1.
From the FDA Drug Label
The development of a potentially life-threatening serotonin syndrome has been reported with SNRIs and SSRIs, including sertraline, alone but particularly with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, and St John’s Wort) and with drugs that impair metabolism of serotonin (in particular, MAOIs, both those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue). If concomitant use of sertraline with other serotonergic drugs including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, buspirone, tryptophan, and St. John’s Wort is clinically warranted, patients should be made aware of a potential increased risk for serotonin syndrome, particularly during treatment initiation and dose increases
The chances of developing serotonin syndrome when taking cabergoline and sertraline together are increased due to the concomitant use of other serotonergic drugs. Cabergoline is a dopamine agonist that can have serotonergic properties, which may increase the risk of serotonin syndrome when combined with sertraline, a selective serotonin reuptake inhibitor (SSRI) 2. Patients should be monitored for the emergence of serotonin syndrome, particularly during treatment initiation and dose increases. Treatment with sertraline and any concomitant serotonergic agents, including cabergoline, should be discontinued immediately if symptoms of serotonin syndrome occur. Key points to consider:
- Serotonin syndrome is a potentially life-threatening condition
- Concomitant use of sertraline with other serotonergic drugs increases the risk of serotonin syndrome
- Patients should be monitored closely for symptoms of serotonin syndrome
- Treatment should be discontinued immediately if symptoms occur 2
From the Research
Serotonin Syndrome Risk Factors
The risk of developing serotonin syndrome when taking cabergoline and sertraline (a selective serotonin reuptake inhibitor) together is a concern due to the potential for increased serotonin levels. Key points to consider include:
- Serotonin syndrome is a potentially life-threatening condition caused by excess serotonin in the body 3, 4, 5.
- The classic triad of serotonin syndrome includes neuromuscular excitation, autonomic instability, and altered mental status 3.
- Selective serotonin reuptake inhibitors (SSRIs), such as sertraline, can increase the risk of serotonin syndrome when used in combination with other medications that affect serotonin levels 3, 4, 6, 7.
Medication Combinations and Serotonin Syndrome
Specific medication combinations that can increase the risk of serotonin syndrome include:
- Monoamine oxidase inhibitors (MAOIs) and SSRIs 4.
- MAOIs and tricyclic antidepressants 4.
- MAOIs and tryptophan 4.
- MAOIs and pethidine (meperidine) 4.
- Bupropion and SSRIs 6.
- Tramadol and SSRIs 7.
Incidence and Management
The true incidence of serotonin syndrome is unknown due to its underrecognition 3. Management of serotonin syndrome typically involves discontinuation of the offending medication and supportive care, with some cases requiring treatment with antiserotonergic drugs such as cyproheptadine or methysergide 3, 4, 5.