Editing Serotonin (section)

===Cardiac fibrosis and other fibroses===
Some serotonergic agonist drugs cause fibrosis anywhere in the body, particularly the syndrome of [[retroperitoneal fibrosis]], as well as [[cardiac fibrosis|cardiac valve fibrosis]].<ref name="Baskin">{{cite book | vauthors = Baskin SI|title = Principles of cardiac toxicology|publisher = CRC Press|location = Boca Raton|year = 1991|isbn = 978-0-8493-8809-5|url = https://books.google.com/books?id=AW7M6jBixj4C&pg=PA626|access-date = 3 February 2010}}</ref>

In the past, three groups of serotonergic drugs have been epidemiologically linked with these syndromes. These are the serotonergic vasoconstrictive antimigraine drugs ([[ergotamine]] and [[methysergide]]),<ref name=Baskin/> the serotonergic appetite suppressant drugs ([[fenfluramine]], [[chlorphentermine]], and [[aminorex]]), and certain anti-Parkinsonian dopaminergic agonists, which also stimulate serotonergic 5-HT<sub>2B</sub> receptors. These include [[pergolide]] and [[cabergoline]], but not the more dopamine-specific [[lisuride]].<ref name="urluserpage.fu-berlin.de">{{cite web|url = http://userpage.fu-berlin.de/~hpertz/Presentation001.pdf|title = Pergolide and Cabergoline But not Lisuride Exhibit Agonist Efficacy at Serotonin 5-HT<sub>2B</sub> Receptors| vauthors = Jähnichen S, Horowski R, Pertz H |access-date = 3 February 2010}}</ref>

As with fenfluramine, some of these drugs have been withdrawn from the market after groups taking them showed a statistical increase of one or more of the side effects described. An example is [[pergolide]]. The drug was declining in use since it was reported in 2003 to be associated with cardiac fibrosis.<ref name="ADRAC_2004">{{cite journal |year=2004 |title=Cardiac valvulopathy with pergolide |journal=Aust Adv Drug React Bull |volume=23 |issue=4 | author = Adverse Drug Reactions Advisory Committee, Australia |url=http://www.tga.gov.au/adr/aadrb/aadr0408.htm | url-status = dead | archive-url = https://web.archive.org/web/20120627200919/http://www.tga.gov.au/adr/aadrb/aadr0408.htm |archive-date=27 June 2012 }}</ref>

Two independent studies published in ''[[The New England Journal of Medicine]]'' in January 2007 implicated pergolide, along with [[cabergoline]], in causing [[valvular heart disease]].<ref name="pmid17202453">{{cite journal | vauthors = Schade R, Andersohn F, Suissa S, Haverkamp W, Garbe E | title = Dopamine agonists and the risk of cardiac-valve regurgitation | journal = The New England Journal of Medicine | volume = 356 | issue = 1 | pages = 29–38 | date = January 2007 | pmid = 17202453 | doi = 10.1056/NEJMoa062222 | doi-access = free }}</ref><ref name="pmid17202454">{{cite journal | vauthors = Zanettini R, Antonini A, Gatto G, Gentile R, Tesei S, Pezzoli G | title = Valvular heart disease and the use of dopamine agonists for Parkinson's disease | journal = The New England Journal of Medicine | volume = 356 | issue = 1 | pages = 39–46 | date = January 2007 | pmid = 17202454 | doi = 10.1056/NEJMoa054830 | doi-access = free }}</ref> As a result of this, the [[Food and Drug Administration|FDA]] removed pergolide from the United States market in March 2007.<ref>{{cite web |url=https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm152695.htm |title=Food and Drug Administration Public Health Advisory |website=[[Food and Drug Administration]] |date=29 March 2007 |access-date=7 February 2010}}</ref> (Since cabergoline is not approved in the United States for Parkinson's Disease, but for hyperprolactinemia, the drug remains on the market. Treatment for hyperprolactinemia requires lower doses than that for Parkinson's Disease, diminishing the risk of valvular heart disease).<ref name="FDAwithdraw">{{cite web|url = https://www.fda.gov/medwatch/safety/2007/safety07.htm#Pergolide|title = MedWatch – 2007 Safety Information Alerts. Permax (pergolide) and generic equivalents|publisher = United States [[Food and Drug Administration]]|date = 29 March 2007|access-date = 30 March 2007}}</ref>