Interactions : אינטראקציות

4.5 Interactions with other medicinal products and other forms of interaction
Contraindicated combination
Levodopa or dopaminergic agonists and metoclopramide have a mutual antagonism (see section 4.3).

Combination to be avoided
Alcohol potentiates the sedative effect of metoclopramide.

Combination to be taken into account
Due to the prokinetic effect of metoclopramide, the absorption of certain drugs may be modified.
Anticholinergics and morphine derivatives
Anticholinergics and morphine derivatives may both have a mutual antagonism with metoclopramide on the digestive tract motility.

Central nervous system depressants (morphine derivatives, anxiolytics , sedative H1- antihistamines, sedative antidepressants, barbiturates, clonidine and related) Sedative effects of Central Nervous System depressants and metoclopramide are potentiated.

Neuroleptics
Metoclopramide may have an additive effect with other neuroleptics on the occurrence of extrapyramidal disorders.

Serotonergic drugs
The use of metoclopramide with serotonergic drugs such as SSRIs may increase the risk of serotonin syndrome.

Digoxin
Metoclopramide may decrease digoxin bioavailability. Careful monitoring of digoxin plasma concentration is required.

Cyclosporine
Metoclopramide increases cyclosporine bioavailability (Cmax by 46% and exposure by 22% ).
Careful monitoring of cyclosporine plasma concentration is required. The clinical consequence is uncertain.
Mivacurium and suxamethonium
Metoclopramide injection may prolong the duration of neuromuscular block (through inhibition of plasma cholinesterase).

Strong CYP2D6 inhibitors
Metoclopramide exposure levels are increased when co-administered with strong CYP2D6 inhibitors such as fluoxetine and paroxetine. Although the clinical significance is uncertain, patients should be monitored for adverse reactions.
The effects of certain other drugs with potential central stimulant effects, e.g. monoamine oxidase inhibitors and sympathomimetics, may be modified when prescribed with metoclopramide and their dosage may need to be adjusted accordingly.

Aspirin, paracetamol
The effect of metoclopramide on gastric motility may modify the absorption of other concurrently administered oral drugs from the gastro-intestinal tract either by diminishing absorption from the stomach or by enhancing the absorption from the small intestine (e.g. the effects of paracetamol and aspirin are enhanced).

Atovaquone
Metoclopramide may reduce plasma concentrations of atovaquone.

Rifampicin
In a published study conducted in 12 healthy volunteers, the administration of 600 mg of rifampicin for 6 days led to reduced plasma metoclopramide exposure (AUC area under the curve) and maximum concentration (Cmax) by 68% and 35%, respectively.
Although the clinical significance is uncertain when metoclopramide is combined with rifampicin, or with other strong inducers (e.g. carbamazepine, phenobarbital, phenytoin), patients should be monitored for a possible lack of anti-emetic activity.