Drug interactions
Metoclopramide intranasal + Paroxetine
Severity: Major
Metoclopramide intranasal and Paroxetine: 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
Paroxetine strongly inhibits CYP2D6 and raises metoclopramide exposure, increasing extrapyramidal symptoms, tardive dyskinesia and sedation. Both drugs can also cause serotonin toxicity or neuroleptic malignant syndrome in rare cases. The fixed intranasal dose cannot be reduced.
What this interaction means in plain words
Metoclopramide intranasal 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.
Why it happens
CYP2D6 inhibition by paroxetine increases metoclopramide exposure, with additive serotonergic and dopaminergic effects.
What to do
Avoid intranasal metoclopramide with strong CYP2D6 inhibitors. Consider an oral metoclopramide dose reduction or an alternative antiemetic.
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 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 intranasal with Paroxetine?
MediHelp rates the interaction as major. Metoclopramide intranasal 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 strongly inhibits CYP2D6 and raises metoclopramide exposure, increasing extrapyramidal symptoms, tardive dyskinesia and sedation. Both drugs can also cause serotonin toxicity or neuroleptic malignant syndrome in rare cases. The fixed intranasal dose cannot be reduced.
How serious is the interaction between Metoclopramide intranasal 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: Avoid intranasal metoclopramide with strong CYP2D6 inhibitors. Consider an oral metoclopramide dose reduction or an alternative antiemetic.
What other medicines interact with Paroxetine?
MediHelp also lists interactions of Paroxetine with, for example, Isocarboxazid, Methylene blue, Phenelzine. The full list is on the Paroxetine page.
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