11 Metoclopramide Interactions to Watch For

Metoclopramide (Reglan, Gimoti) is a prescription medication. It treats gastroesophageal reflux disease (GERD) and gastroparesis (delayed emptying of the stomach) from diabetes. Sometimes it is used off-label to treat other conditions.

Metoclopramide can help relieve bothersome symptoms of these conditions. But it has risks as well, including side effects and drug interactions. If you’re prescribed this medication, here are 11 metoclopramide interactions to consider.

1. Alcohol

Alcohol and metoclopramide can each make you drowsy and affect your ability to focus. When the two are combined, these side effects can worsen. This increases your risk of falls and injuries. In severe cases, your breathing could slow down and make it difficult to breathe. This is an emergency and requires immediate care.

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So if you’re taking metoclopramide, it’s best to avoid drinking alcohol. With conditions like GERD, alcohol may make GERD symptoms worse.

Be honest with your prescriber about your alcohol consumption while taking metoclopramide. They may suggest trying a different medication if you drink alcohol.

2. Antipsychotics

Antipsychotics are a group of medications that treat mental health conditions, including bipolar disorder. Examples include haloperidol (Haldol), olanzapine (Zyprexa), and risperidone (Risperdal).

Both antipsychotics and metoclopramide can cause involuntary muscle movements. These are known as extrapyramidal symptoms (EPSs). EPSs include restlessness, tremors (shakiness), and abnormal twisting of the body. Combining metoclopramide and antipsychotic medications increases the risk of developing EPSs.

Rarely, this interaction can lead to a more serious condition called tardive dyskinesia. This is a movement disorder that causes uncontrolled movements in the body.

In most cases, it’s best to avoid taking antipsychotics with metoclopramide. This is especially true for antipsychotics that are more known to cause movement problems. These include haloperidol and risperidone.

3. Some antidepressants

Antidepressants called monoamine oxidase inhibitors (MAOIs) can interact with metoclopramide. Examples include selegiline (Zelapar) and phenelzine (Nardil). Both MAOIs and metoclopramide affect several chemical messengers in the brain. Abnormal levels of these chemicals may lead to high blood pressure and other negative effects. That’s why MAOIs and metoclopramide shouldn’t be combined in most cases.

Other antidepressants, like fluoxetine (Prozac), paroxetine (Paxil, Brisdelle), and bupropion (Wellbutrin SR, Wellbutrin XL), can also interact with metoclopramide. These medications can block an enzyme that’s responsible for breaking down metoclopramide.

Medications that block its metoclopramide metabolism can increase metoclopramide levels in the blood. This can raise your risk of side effects, including restlessness, drowsiness, and movement problems. In some cases, your prescriber may lower your metoclopramide dose if you take one of these medications.

Keep in mind, other medications may also increase metoclopramide levels. It’s a good idea to give your prescriber and pharmacist an up-to-date list of your current medications. Include supplements and over-the-counter products. This will help them check for any medications that might increase metoclopramide levels.

4. Benzodiazepines

Benzodiazepines are medications that treat several health conditions, including anxiety. Examples include diazepam (Valium) and alprazolam (Xanax).

Benzodiazepines and metoclopramide have some similar side effects. This includes drowsiness, dizziness, and confusion. Combining benzodiazepines and metoclopramide may result in oversedation and trouble balancing. This can lead to serious risks like injuries and falls. It can also make it difficult to safely perform everyday tasks, such as driving.

If you’re taking metoclopramide, it’s best to avoid benzodiazepines.

5. Opioids

Opioids are medications that treat moderate-to-severe pain that can’t be relieved by other pain medications. Examples include hydrocodone / acetaminophen, oxycodone (Roxicodone, Oxycontin), and tramadol (ConZip, Qdolo).

Opioids and metoclopramide can affect your brain, making you feel drowsy and dizzy. When taken together, these side effects can become even more intense. In rare but severe cases, this combination can slow down your breathing and lead to an overdose. What’s more, opioids can also slow down your gut. This can block metoclopramide from being fully absorbed. And it can make metoclopramide less effective.

In some cases, these medications can be used together. But it’s usually best to avoid combining opioids and metoclopramide. If this combination causes low blood pressure, slowed breathing, or unconsciousness, seek emergency care. These are signs of an overdose. Administer naloxone (Narcan) — the opioid overdose antidote — immediately if you have it.

6. Loperamide and other antidiarrheals

Certain medications that treat diarrhea can interact with metoclopramide. This includes diphenoxylate / atropine (Lomotil) and loperamide (Imodium-AD). These medications work by slowing down your gut to help relieve diarrhea. But by slowing your gut, they may prevent metoclopramide from being absorbed as well as it should. This can make metoclopramide less effective.

If you have diarrhea while taking metoclopramide, ask your prescriber if there’s a safe antidiarrheal option. For example, bismuth subsalicylate (Pepto-Bismol) may be a safer alternative for you.

7. Anticholinergic medications

Anticholinergics are another group of medications that can slow down your gut. This may decrease metoclopramide absorption and make it less effective. This is also a common reason why anticholinergics cause constipation: They slow down the movement of food in your gut.

Examples of anticholinergic medications include oxybutynin (Ditropan XL), hyoscyamine (Levsin), and glycopyrrolate (Robinul). Other medications aren’t anticholinergic medications, but they have similar properties. So they can cause several of the same side effects. These include diphenhydramine (Benadryl).

Several hundred medications have anticholinergic properties. So if you take any anticholinergic medications, ask your pharmacist before starting metoclopramide. They can tell you what interactions may exist.

8. Medications that increase dopamine levels

Dopamine is a naturally occurring chemical messenger in your brain. It helps regulate your digestive system by controlling muscle movement in your stomach.

Metoclopramide works by lowering dopamine levels in the body. But other medications, like those used to treat Parkinson’s disease, do the opposite. They raise dopamine levels instead. Examples include pramipexole (Mirapex), ropinirole, and carbidopa / levodopa (Sinemet).

Combining metoclopramide and dopamine-boosting medications may affect how well they work. For example, carbidopa / levodopa improves Parkinson’s disease symptoms by increasing dopamine levels. So if you take metoclopramide, your dopamine levels may not increase as you would expect.

But dopamine-boosting medications can make metoclopramide less effective. If you take a combination of these medications, look for signs of an interaction. This may be Parkinson’s symptoms that don’t improve or worsen. Or you may notice that your GERD or gastroparesis symptoms don’t get better.

9. Insulin

Insulin is a medication that treats diabetes. It works by lowering blood glucose (sugar) levels in the body.

As mentioned, metoclopramide works by moving food more quickly through your gastrointestinal tract. So after you eat, metoclopramide helps that food get absorbed. As a result, you may experience larger (or quicker) spikes in your blood glucose after eating.

If you take metoclopramide, your prescriber may want you to check your blood glucose levels more often. Or they may adjust the amount of insulin you take and the time you take it.

10. Transplant medications

Sirolimus (Rapamune), tacrolimus (Prograf), and cyclosporine (Sandimmune) are immunosuppressant medications. They’re used to prevent your body from rejecting an organ transplant.

Metoclopramide speeds up the delivery of these medications to your small intestine (where they’re absorbed). This can increase levels of these medications in the body and raise your risk of side effects. If you’re taking metoclopramide and tacrolimus together, you may be more likely to experience tacrolimus side effects.

If you need to take an immunosuppressant with metoclopramide, your prescriber may monitor you more closely. They may also consider adjusting your dosages of these medications.

11. Digoxin

Digoxin (Lanoxin) is a heart medication that has many possible drug interactions. Combining metoclopramide and digoxin can decrease digoxin absorption and make it less effective. Some people have also experienced a low heart rate (bradycardia) from this interaction. Each medication can decrease heart rate on its own, but when combined it could be worse.

If you’re taking digoxin and metoclopramide, your prescriber may change your dosages. But digoxin is a “narrow therapeutic index” medication. This means even a slight change in dose can have significant effects. So they’ll likely ask you to complete blood work to check if your digoxin dose is right.

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Written by:

Makaela Premont, PharmD

Makaela Premont, PharmD, is a pharmacist and the founder of uniquelymickie.com, a website dedicated to helping pharmacy students and pharmacists create a life that they enjoy. She received her Doctorate of Pharmacy from the University of South Carolina and is a licensed pharmacist in North Carolina.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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