Drug interactions
Fluoxetine + Metoclopramide
Severity: Major
Fluoxetine 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
Fluoxetine strongly inhibits CYP2D6, which metabolises metoclopramide, so metoclopramide exposure can increase and extrapyramidal reactions become more likely. Additive serotonergic effects may also raise the risk of serotonin syndrome.
What this interaction means in plain words
Fluoxetine 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.
Fluoxetine belongs to Central Nervous System; Metoclopramide belongs to Gastrointestinal Tract.
Why it happens
CYP2D6 inhibition by fluoxetine reduces metoclopramide clearance, plus additive serotonergic and dopamine-blocking effects.
What to do
Reduce the metoclopramide dose (labeling advises a lower dose with strong CYP2D6 inhibitors) and keep treatment short. Monitor for dystonia, parkinsonism, akathisia and signs of serotonin toxicity.
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?
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References
Other interactions of Metoclopramide
Other interactions of Fluoxetine
- Fluoxetine + Isocarboxazid Contraindicated
- Fluoxetine + Mavacamten Contraindicated
- Fluoxetine + Methylene blue Contraindicated
- Fluoxetine + Phenelzine Contraindicated
- Fluoxetine + Pimozide Contraindicated
- Fluoxetine + Rasagiline Contraindicated
Frequently asked questions
Can I take Fluoxetine with Metoclopramide?
MediHelp rates the interaction as major. Fluoxetine 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. Fluoxetine strongly inhibits CYP2D6, which metabolises metoclopramide, so metoclopramide exposure can increase and extrapyramidal reactions become more likely. Additive serotonergic effects may also raise the risk of serotonin syndrome.
How serious is the interaction between Fluoxetine 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: Reduce the metoclopramide dose (labeling advises a lower dose with strong CYP2D6 inhibitors) and keep treatment short. Monitor for dystonia, parkinsonism, akathisia and signs of serotonin toxicity.
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.
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