Posted by undopaminergic on June 30, 2008, at 6:30:01
In reply to How's the Dostinex Working?, posted by atmlady on June 25, 2008, at 21:19:10
> Hello, Jay - How are you liking the Dostinex? How much do you take and how often? Just curious, as I saw my pdoc today, who told me I needed some dopamine in addition to my ixel+provigil cocktail. She prescribed Wellbutrin 75 in the a.m. only (immediate release I suppose, not the XL). So. I'll be adding that on Friday morning. But just in case I'm looking at other sources of dopamine and spotted your post.
>Provigil is (almost certainly) a more powerful dopaminergic agent than Wellbutrin, but the latter may be more effective as an antidepressant in general. For dopaminergic augmentation, however, methylphenidate (Ritalin, Concerta, etc.) or dextroamphetamine (Dexedrine) would seem more suitable choices.
As for cabergoline (Dostinex, Cabaser), alas, it is one of those dopamine (DA) agonists that are associated with a serious risk of cardiac valvulopathy and other severe adverse effects if used extensively. The same goes for pergolide (Permax), and to a lesser extent bromocriptine (Parlodel). In fact, as a general rule, and in the absence of more specific information, it may be prudent to regard all ergot-based drugs as suspect.
The non-ergot DA agonists are apomorphine, ropinirole, pramipexole, piribedil, quinagolide, rotigotine, and possibly others. I recall that you've already tried one or two of them. Apomorphine may have the best DA receptor binding profile, but it's troublesome in terms of a short half-life and the necessity of parenteral adminitration.
Low doses of aripiprazole (Abilify) may be worthy of consideration due to its partial agonist action at DA D2 receptors.
Sulpiride and amisulpride can be very effective dopaminergic agents at low doses. They are less likely to cause sleepiness than most - or all - of the DA direct agonists mentioned above.
Etc... I've probably overlooked a lot of what should be mentioned.
poster:undopaminergic
thread:835768
URL: http://www.dr-bob.org/babble/20080626/msgs/837262.html