Drug interactions
Metoclopramide intranasal + Pimavanserin
Severity: Moderate
Metoclopramide intranasal and Pimavanserin: moderate 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
Metoclopramide is a dopamine D2 antagonist associated with extrapyramidal symptoms, tardive dyskinesia and rarely neuroleptic malignant syndrome. Pimavanserin does not block D2 receptors, so a strong additive effect is not expected, but it is an antipsychotic with some theoretical overlap. Metoclopramide may also worsen parkinsonism in the Parkinson's disease patients who take pimavanserin.
What this interaction means in plain words
Metoclopramide intranasal and Pimavanserin can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Why it happens
Metoclopramide's D2 blockade can worsen motor symptoms; the contribution of pimavanserin is theoretical.
What to do
Avoid metoclopramide in Parkinson's disease patients where possible and use an alternative antiemetic such as domperidone where available or ondansetron with ECG caution. Monitor for new or worsening movement disorder.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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 intranasal with Pimavanserin?
MediHelp rates the interaction as moderate. Metoclopramide intranasal and Pimavanserin can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Metoclopramide is a dopamine D2 antagonist associated with extrapyramidal symptoms, tardive dyskinesia and rarely neuroleptic malignant syndrome. Pimavanserin does not block D2 receptors, so a strong additive effect is not expected, but it is an antipsychotic with some theoretical overlap. Metoclopramide may also worsen parkinsonism in the Parkinson's disease patients who take pimavanserin.
How serious is the interaction between Metoclopramide intranasal and Pimavanserin?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid metoclopramide in Parkinson's disease patients where possible and use an alternative antiemetic such as domperidone where available or ondansetron with ECG caution. Monitor for new or worsening movement disorder.
What other medicines interact with Pimavanserin?
MediHelp also lists interactions of Pimavanserin with, for example, Lefamulin, Pimozide, Vandetanib. The full list is on the Pimavanserin page.
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