Open Community Question @RefluxReset_MA • 45-59F • 10mg dapagliflozin + 50mg se • Week 16

▲ 36 Helpful • 2 Peer Replies

Dapagliflozin 10mg + sertraline, stopped 5-HTP, walk + vitamin D check (16 wks update): Summary from a 47-year-old with type 2 diabetes, early CKD (UACR 85 mg/g), sleep trouble,... — what worked for others here?

Summary from a 47-year-old with type 2 diabetes, early CKD (UACR 85 mg/g), sleep trouble, and acne on tretinoin. Meds: dapagliflozin 10 mg at 8 a.m., metformin 500 mg twice daily, and sertraline 50 mg. I had started 5-HTP 100 mg at night for sleep, but my pharmacist flagged the risk of excess serotonin with sertraline, so I stopped it and my prescriber reviewed my sleep plan instead. What helped: a 15-minute walk after dinner, ending at least 2 hours before bed, and a fixed wake time. My 25-OH vitamin D was 19 ng/mL, so I took 1,000-2,000 IU D3 daily per clinician advice and rechecked at week 12 (31 ng/mL). I used tretinoin 0.025% every other night with morning sunscreen. Results: sleep onset improved from about 60 to 30 minutes, A1c went from 7.4% to 6.8%, and UACR fell to 52 mg/g.

⚕ Pinned FDA / NIH / PubMed Clinical Context • Nourhan Mansour — Literature & Label Auditor

The sertraline label and FDA guidance warn that serotonergic agents can raise the risk of serotonin syndrome, and 5-HTP is a direct serotonin precursor. NIH ODS lists 4,000 IU/day as the tolerable upper intake level for vitamin D in adults, and 20 ng/mL is commonly used as the adequacy cutoff.

Connected Clinical Guides: Condition: Type 2 Diabetes Condition: Diabetes Type 2 Condition: Prediabetes Rx: Metformin Rx: Metformin Hcl Rx: Tirzepatide Supplement: Vitamin B12 Supplement: Magnesium Glycinate Supplement: Berberine

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Verified Peer Replies (2)

@FerritinClimb_PA • Verified Cohort Member • Week 8

Stopping 5-HTP with sertraline was a sound call. Case reports describe serotonin toxicity with the combination, and supplement doses are not standardized. Symptoms to watch include agitation, sweating, tremor, fast heartbeat, and diarrhea. Also tell your prescriber about every supplement, since insomnia may relate to nocturia, mood, or blood sugar swings.

@MorningFocus_IL • Age 30-44 • Week 10

I use tretinoin every other night too, and my dermatologist said to apply a pea-sized amount to dry skin and use SPF 30+ in the morning. I moved my evening walk earlier to avoid sunburn and found sunscreen plus a hat easy to add.