Both are dopamine antagonists; additive extrapyramidal effects (tremors, restlessness)
Management: Avoid concurrent use. If needed, reduce doses and monitor for neurological signs.
Opioids slow GI motility (anti-prokinetic). Metoclopramide stimulates GI motility (prokinetic). Pharmacologically opposing effects.
Management: Metoclopramide antiemetic effect (D2 blockade) is preserved, but prokinetic effect is reduced by concurrent opioids. For prokinetic benefit, may need higher metoclopramide dose.
Both increase GI motility but via different mechanisms. Additive prokinetic effect may cause excessive GI motility (cramping, diarrhea).
Management: Usually not needed together — use one prokinetic. If combined, monitor for excessive GI motility signs.
Metoclopramide (D2 antagonist) + tramadol (serotonin reuptake inhibitor): increased extrapyramidal and serotonergic risk. Also, tramadol slows GI motility opposing metoclopramide.
Management: Use with caution. Monitor for extrapyramidal signs and serotonin syndrome. Maropitant may be preferred antiemetic with tramadol.
Atropine (anticholinergic) antagonizes metoclopramide's prokinetic effect (which depends on cholinergic facilitation). Antiemetic D2 blockade by metoclopramide is not affected.
Management: Prokinetic effect is reduced, but antiemetic effect preserved. Avoid combining if prokinetic goal is primary.
Cyclosporine (Systemic)
moderateMetoclopramide increases GI motility, potentially increasing cyclosporine absorption rate and peak levels.
Management: Monitor cyclosporine levels if metoclopramide added. Usually clinically modest effect.
Glycopyrrolate (anticholinergic) antagonizes metoclopramide's prokinetic effect. Antiemetic D2 blockade of metoclopramide is preserved.
Management: Avoid combining if prokinetic effect is desired. If anticholinergic needed for bradycardia during procedure, metoclopramide prokinetic benefit will be lost.