When to Stop

• Impulse Control Disorders (ICDs) — class warning across all DA agonists. Pathological gambling, hypersexuality, compulsive shopping, binge eating, punding, compulsive medication use. Population rate in PD on DA agonists 2.8-8% vs. ~1% baseline. Lisuride-specific signal: in a 2002-2018 review of 94 suspected dopamine-agonist gambling cases, zero cases involved lisuride — but lisuride use is also far smaller than pramipexole/ropinirole, so denominator effects matter. Class-warning language for ICDs is in the lisuride SmPC. This is the single most important risk for a 20-year-old.
• Cardiac valvulopathy: the elegant 5-HT2B-antagonist mechanism predicts essentially zero risk, and ~360,000 patient-years of pharmacovigilance bear this out. This is lisuride's unique selling point vs. pergolide/cabergoline — and is a real, well-supported claim.
• Pleural / retroperitoneal / pulmonary fibrosis: the older-ergoline class concern (ergotamine, methysergide). Lisuride's 5-HT2B antagonism predicts low risk; pharmacovigilance is consistent with low risk.
• Sudden sleep attacks ("sleep attacks") — class effect of DA agonists, more associated with non-ergolines (pramipexole/ropinirole) but reported with lisuride.
• Psychiatric decompensation in vulnerable individuals (psychosis, mania).
• Ergotism / vasoconstrictive effects (theoretically; very rare with lisuride compared to ergotamine/dihydroergotamine).
• Hepatic enzyme elevations (rare).
• First 4-8 weeks: nausea, orthostasis, sleep disturbance — worst at start, often improves with continued use.
• Months 3-12+: ICD onset typically begins within first year of dopamine agonist use. Self-monitoring is unreliable (the impulsive behavior often does not feel pathological from inside it). Partner / family monitoring matters.
• Indefinite (if chronic use): baseline echo recommended in PD-dose chronic use even though valvulopathy risk is low (regulatory carryover from ergoline class).