Hi doctor,
I take Prozac 40 mg for a long time as a constant treatment by the specialist for GAD and SAD (chronic case). My weight is 93 kg, and my height is 175 cm. I take Crestor 2.5 mg daily. I do not have any other problems or illnesses. I am doing nearly well on Prozac, comparable with other SSRIs I used before, especially regarding weight gain. But I have one big problem, and I want to treat it. I have erectile dysfunction and cannot maintain the erection solid and hard for a proper time and other sexual problems. And I am not planning to replace Prozac because it alleviates my chronic anxiety. I also have fatigue and tiredness sometimes.
My doctor added Wellbutrin XL 150 mg previously to Prozac, and I tried it but did not resolve the sexual problems at all, just helping me in regards to fatigue. So we deleted it. Also, I tried 2.5 mg Cialis daily, and it is better but does not resolve the issue to a reasonable extent. So my doctor suggested adding Cabergoline 0.5 mg twice weekly with Prozac 40 mg and Cialis 2.5 mg. He said it is off-label and is very useful to encounter sexual side effects of Prozac. Do you agree? Is it a safe medication to add overall? And what are its side effects? Or should I use Prozac and only upgrade Cialis to 5 mg daily without adding any new medication? So these are my questions, and I will discuss your answers with my specialist when I visit him soon, and I need an extra opinion.
Thank you and best regards.
Hi,
Welcome to icliniq.com.
I am happy to give you a second opinion on your problem. I can see the dilemma regarding your GAD (generalized anxiety disorder) treatment and erectile dysfunction (ED). I like to summarize your problems. You have,
1) Generalized anxiety disorder (GAD).
2) Social anxiety disorder (SAD).
3) Erectile dysfunction (ED).
4) Obesity (body mass index more than 30).
And your medication list is,
1) Prozac (Fluoxetine) 40 mg.
2) Crestor (Rosuvastatin) 2.5 mg.
3) Cialis (Tadalafil).
4) In past, Wellbutrin XL ( Bupropion) 150 mg.
5) In future, Cabergoline 0.5 mg.
Here is my opinion,
First, we need to understand the exact cause of your ED. Medication side effects could be one of the causes, but other factors might also play a role (one piece of evidence is that you did not improve with Wellbutrin). Your obesity, GAD, SAD, etc., could be the causes. I do not know whether you smoke or not. So, only stopping or changing Prozac is not the solution.
The second is to identify the cause of ED. Finally, you need thorough investigations (lipid profile, blood glucose, testosterone, prolactin, thyroid function, etc.) if not done already.
Thirdly Cabergoline could be tried for few months to see how you feel. But remember, since it is off-label, efficacy is unpredictable.
Fourth, about safety. Cabergoline is similar to one of our body’s reward hormones called Dopamine. So in that dosage range, it would be safe.
Fifth, the side effects of Cabergoline are nausea, vomiting, heartburn, constipation, tiredness, dizziness, breast pain, burning sensation, numbness, or tingling in the arms, hands, legs, or feet.
To answer your question regarding monotherapy with Prozac or continue Cialis or other options, your problem needs a holistic approach. It means you need to change your lifestyle, do regular exercise, diet modification, weight loss, and psychotherapy in addition to medications.
Regarding follow up:
I would be happy to answer any further queries.
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