Drug interactions
Metoclopramide + Tramadol
Severity: Major
Metoclopramide and Tramadol: major interaction.
Last updated Sources: US FDA label
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 the two raises the risk of seizures and serotonin syndrome, and tramadol's opioid action opposes metoclopramide's prokinetic effect. Metoclopramide, a CYP2D6 substrate and weak inhibitor, may also reduce formation of tramadol's active metabolite.
What this interaction means in plain words
Metoclopramide and Tramadol 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; Tramadol belongs to Musculoskeletal.
Why it happens
Additive lowering of seizure threshold and serotonergic effects, with opioid antagonism of prokinetic action and possible CYP2D6 inhibition.
What to do
Avoid the combination in patients with seizure risk; otherwise monitor for serotonin toxicity, seizures and reduced analgesia, and consider a different analgesic.
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 Tramadol
- Isocarboxazid + Tramadol Contraindicated
- Olanzapine / samidorphan + Tramadol Contraindicated
- Phenelzine + Tramadol Contraindicated
- Procarbazine + Tramadol Contraindicated
- Rasagiline + Tramadol Contraindicated
- Safinamide + Tramadol Contraindicated
Frequently asked questions
Can I take Metoclopramide with Tramadol?
MediHelp rates the interaction as major. Metoclopramide and Tramadol 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 the two raises the risk of seizures and serotonin syndrome, and tramadol's opioid action opposes metoclopramide's prokinetic effect. Metoclopramide, a CYP2D6 substrate and weak inhibitor, may also reduce formation of tramadol's active metabolite.
How serious is the interaction between Metoclopramide and Tramadol?
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 in patients with seizure risk; otherwise monitor for serotonin toxicity, seizures and reduced analgesia, and consider a different analgesic.
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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