Drug interactions
Metoclopramide + Pimavanserin
Severity: Major
Metoclopramide and Pimavanserin: 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
Pimavanserin is an antipsychotic acting on serotonin receptors and carries a QT prolongation risk. Combined with metoclopramide, a dopamine antagonist, the risk of extrapyramidal symptoms, tardive dyskinesia and neuroleptic malignant syndrome may increase, particularly in Parkinson disease psychosis where dopamine blockade worsens motor symptoms.
What this interaction means in plain words
Metoclopramide and Pimavanserin 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; Pimavanserin belongs to Central Nervous System.
Why it happens
Additive central antipsychotic and dopamine antagonist effects with additive QT prolongation potential.
What to do
Avoid the combination, especially in Parkinson disease, and use an antiemetic without central dopamine antagonism such as domperidone where available or ondansetron with ECG monitoring. If unavoidable, monitor for movement disorders and QT changes.
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 Metoclopramide and Pimavanserin, 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.
Other interactions of Metoclopramide
Other interactions of Pimavanserin
- Lefamulin + Pimavanserin Contraindicated
- Pimavanserin + Pimozide Contraindicated
- Pimavanserin + Vandetanib Contraindicated
- Adagrasib + Pimavanserin Major
- Amiodarone + Pimavanserin Major
- Amisulpride + Pimavanserin Major
Frequently asked questions
Can I take Metoclopramide with Pimavanserin?
MediHelp rates the interaction as major. Metoclopramide and Pimavanserin 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. Pimavanserin is an antipsychotic acting on serotonin receptors and carries a QT prolongation risk. Combined with metoclopramide, a dopamine antagonist, the risk of extrapyramidal symptoms, tardive dyskinesia and neuroleptic malignant syndrome may increase, particularly in Parkinson disease psychosis where dopamine blockade worsens motor symptoms.
How serious is the interaction between Metoclopramide and Pimavanserin?
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 the combination, especially in Parkinson disease, and use an antiemetic without central dopamine antagonism such as domperidone where available or ondansetron with ECG monitoring. If unavoidable, monitor for movement disorders and QT changes.
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.
