Drug interactions
Metoclopramide + Paroxetine
Severity: Major
Metoclopramide and Paroxetine: 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
Paroxetine is a potent CYP2D6 inhibitor and can substantially raise metoclopramide levels, increasing the risk of extrapyramidal symptoms. Additive serotonergic effects may also contribute to serotonin syndrome.
What this interaction means in plain words
Metoclopramide and Paroxetine 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.
Metoclopramide belongs to Gastrointestinal Tract; Paroxetine belongs to Central Nervous System.
Why it happens
Strong CYP2D6 inhibition by paroxetine reduces metoclopramide metabolism, plus additive serotonergic and antidopaminergic effects.
What to do
Lower the metoclopramide dose in line with labeling for strong CYP2D6 inhibitors and limit treatment duration. Monitor for dystonia, parkinsonism, akathisia and 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 Paroxetine
- Isocarboxazid + Paroxetine Contraindicated
- Methylene blue + Paroxetine Contraindicated
- Paroxetine + Phenelzine Contraindicated
- Paroxetine + Pimozide Contraindicated
- Paroxetine + Procarbazine Contraindicated
- Paroxetine + Selegiline Contraindicated
Frequently asked questions
Can I take Metoclopramide with Paroxetine?
MediHelp rates the interaction as major. Metoclopramide and Paroxetine 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. Paroxetine is a potent CYP2D6 inhibitor and can substantially raise metoclopramide levels, increasing the risk of extrapyramidal symptoms. Additive serotonergic effects may also contribute to serotonin syndrome.
How serious is the interaction between Metoclopramide and Paroxetine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Lower the metoclopramide dose in line with labeling for strong CYP2D6 inhibitors and limit treatment duration. Monitor for dystonia, parkinsonism, akathisia and 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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