Reglan - Interactions Metoclopramide Hydrochloride
This section below outlines the advice given to doctors and pharmacists when prescribing and dispensing Reglan
Drug Interactions
effects of other drugs on metoclopramide
Table 3 displays the effects of other drugs on metoclopramide.
Table 3. Effects of Other Drugs on Metoclopramide
| Antipsychotics | |
| Clinical Impact | Potential for additive effects, including increased frequency and severity of tardive dyskinesia (TD), other extrapyramidal symptoms (EPS), and neuroleptic malignant syndrome (NMS). |
| Intervention | Avoid concomitant use [see Warnings and Precautions (5.1, 5.2, 5.3)]. |
| Strong CYP2D6 Inhibitors, not Included in Antipsychotic Category Above | |
| Clinical Impact | Increased plasma concentrations of metoclopramide; risk of exacerbation of extrapyramidal symptoms [see Clinical Pharmacology (12.3)]. |
| Intervention | Reduce the Reglan dosage [see Dosage and Administration (2.2, 2.3)]. |
| Examples | quinidine, bupropion, fluoxetine, and paroxetine |
| Monoamine Oxidase Inhibitors | |
| Clinical Impact | Increased risk of hypertension [see Warnings and Precautions (5.5)]. |
| Intervention | Avoid concomitant use. |
| Central Nervous System (CNS) Depressants | |
| Clinical Impact | Increased risk of CNS depression [see Warnings and Precautions (5.8)]. |
| Intervention | Avoid Reglan or the interacting drug, depending on the importance of the drug to the patient. |
| Examples | alcohol, sedatives, hypnotics, opiates and anxiolytics |
| Drugs that Impair Gastrointestinal Motility | |
| Clinical Impact | Decreased systemic absorption of metoclopramide. |
| Intervention | Monitor for reduced therapeutic effect. |
| Examples | antiperistaltic antidiarrheal drugs, anticholinergic drugs, and opiates |
| Dopaminergic Agonists and Other Drugs that Increase Dopamine Concentrations | |
| Clinical Impact | Decreased therapeutic effect of metoclopramide due to opposing effects on dopamine. |
| Intervention | Monitor for reduced therapeutic effect. |
| Examples | apomorphine, bromocriptine, cabergoline, levodopa, pramipexole, ropinirole, and rotigotine |
effects of metoclopramide on other drugs
Table 4 displays the effects of Metoclopramide on other drugs.
Table 4. Effects of Metoclopramide on Other Drugs
| Dopaminergic Agonists and Drugs Increasing Dopamine Concentrations | |
| Clinical Impact | Opposing effects of metoclopramide and the interacting drug on dopamine. Potential exacerbation of symptoms (e.g., parkinsonian symptoms). |
| Intervention | Avoid concomitant use [see Warnings and Precautions (5.2)]. |
| Examples | Apomorphine, bromocriptine, cabergoline, levodopa, pramipexole, ropinirole, rotigotine |
| Succinylcholine, Mivacurium | |
| Clinical Impact | Metoclopramide inhibits plasma cholinesterase leading to enhanced neuromuscular blockade. |
| Intervention | Monitor for signs and symptoms of prolonged neuromuscular blockade. |
| Drugs with Absorption Altered due to Increased Gastrointestinal Motility | |
| Clinical Impact | The effect of metoclopramide on other drugs is variable. Increased gastrointestinal (GI) motility by metoclopramide may impact absorption of other drugs leading to decreased or increased drug exposure. |
| Intervention | Drugs with Decreased Absorption (e.g., digoxin, atovaquone, posaconazole oral suspension*, fosfomycin): Monitor for reduced therapeutic effect of the interacting drug. For digoxin monitor therapeutic drug concentrations and increase the digoxin dose as needed (see prescribing information for digoxin). Drugs with Increased Absorption (e.g., sirolimus, tacrolimus, cyclosporine): Monitor therapeutic drug concentrations and adjust the dose as needed. See prescribing information for the interacting drug. |
| Insulin | |
| Clinical Impact | Increased GI motility by metoclopramide may increase delivery of food to the intestines and increase blood glucose. |
| Intervention | Monitor blood glucose and adjust insulin dosage regimen as needed. |
* Interaction does not apply to posaconazole delayed-release tablets
