Drug interactions
Levomilnacipran + Metoclopramide
Severity: Major
Levomilnacipran and Metoclopramide: major interaction.
Last updated
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
Both drugs have been linked to serotonin toxicity, and metoclopramide also causes extrapyramidal reactions and rarely neuroleptic malignant syndrome. Combination may increase the risk of these neuropsychiatric effects.
What this interaction means in plain words
Levomilnacipran 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.
Levomilnacipran belongs to Central Nervous System; Metoclopramide belongs to Gastrointestinal Tract.
Why it happens
Additive serotonergic activity and dopaminergic blockade, with additive extrapyramidal effects.
What to do
Prefer an alternative antiemetic such as ondansetron with caution regarding serotonergic effects, or limit metoclopramide to short courses. Monitor for agitation, tremor, rigidity, hyperthermia and dystonia.
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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Other interactions of Metoclopramide
Other interactions of Levomilnacipran
- Isocarboxazid + Levomilnacipran Contraindicated
- Levomilnacipran + Linezolid Contraindicated
- Levomilnacipran + Methylthioninium chloride Contraindicated
- Levomilnacipran + Phenelzine Contraindicated
- Levomilnacipran + Procarbazine Contraindicated
- Levomilnacipran + Rasagiline Contraindicated
Frequently asked questions
Can I take Levomilnacipran with Metoclopramide?
MediHelp rates the interaction as major. Levomilnacipran 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. Both drugs have been linked to serotonin toxicity, and metoclopramide also causes extrapyramidal reactions and rarely neuroleptic malignant syndrome. Combination may increase the risk of these neuropsychiatric effects.
How serious is the interaction between Levomilnacipran 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: Prefer an alternative antiemetic such as ondansetron with caution regarding serotonergic effects, or limit metoclopramide to short courses. Monitor for agitation, tremor, rigidity, hyperthermia and dystonia.
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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