Drug interactions
Clozapine + Metoclopramide
Severity: Major
Clozapine and Metoclopramide: major interaction.
Last updated Sources: UK SmPC
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Combining clozapine with metoclopramide may add to dopamine-blocking toxicity, including extrapyramidal symptoms and neuroleptic malignant syndrome. Clozapine has low D2 affinity, but the risk is still raised. Metoclopramide has also been advised against alongside agents that can cause blood dyscrasias.
What this interaction means in plain words
Clozapine and Metoclopramide can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Clozapine belongs to Central Nervous System; Metoclopramide belongs to Gastrointestinal Tract.
Why it happens
Additive dopamine D2 receptor antagonism.
What to do
Avoid where possible and use an antiemetic without D2 antagonism such as ondansetron. If used together, monitor for movement disorders and fever with rigidity.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Clozapine and Metoclopramide, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
References
Other interactions of Metoclopramide
Other interactions of Clozapine
- Clozapine + Deferiprone Contraindicated
- Clozapine + Irinotecan Contraindicated
- Clozapine + Pimozide Contraindicated
- Clozapine + Thioridazine Contraindicated
- Acalabrutinib + Clozapine Major
- Adagrasib + Clozapine Major
Frequently asked questions
Can I take Clozapine with Metoclopramide?
MediHelp rates the interaction as major. Clozapine and Metoclopramide can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Combining clozapine with metoclopramide may add to dopamine-blocking toxicity, including extrapyramidal symptoms and neuroleptic malignant syndrome. Clozapine has low D2 affinity, but the risk is still raised. Metoclopramide has also been advised against alongside agents that can cause blood dyscrasias.
How serious is the interaction between Clozapine and Metoclopramide?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid where possible and use an antiemetic without D2 antagonism such as ondansetron. If used together, monitor for movement disorders and fever with rigidity.
What other medicines interact with Metoclopramide?
MediHelp also lists interactions of Metoclopramide with, for example, Amantadine, Amoxapine, Antipsychotics (e.g., haloperidol). The full list is on the Metoclopramide page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
