Drug interactions
Metoclopramide intranasal + Tramadol
Severity: Moderate
Metoclopramide intranasal and Tramadol: 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 antagonist that can cause extrapyramidal effects and lower the seizure threshold, and tramadol also lowers the seizure threshold and has serotonergic activity. Combined use may raise the risk of seizures, extrapyramidal reactions and serotonin toxicity. Metoclopramide also may reduce the analgesic benefit of opioids through its effect on gastric motility and CNS action, and CYP2D6 inhibition by metoclopramide may reduce activation of tramadol.
What this interaction means in plain words
Metoclopramide intranasal and Tramadol 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
Additive effects on seizure threshold and serotonergic or dopaminergic neurotransmission, plus weak CYP2D6 inhibition by metoclopramide that may reduce tramadol activation.
What to do
Monitor for seizures, extrapyramidal symptoms and signs of serotonin syndrome, and consider an alternative antiemetic or analgesic in patients with seizure risk. Reassess pain control if tramadol seems less effective.
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 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 intranasal with Tramadol?
MediHelp rates the interaction as moderate. Metoclopramide intranasal and Tramadol 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 antagonist that can cause extrapyramidal effects and lower the seizure threshold, and tramadol also lowers the seizure threshold and has serotonergic activity. Combined use may raise the risk of seizures, extrapyramidal reactions and serotonin toxicity. Metoclopramide also may reduce the analgesic benefit of opioids through its effect on gastric motility and CNS action, and CYP2D6 inhibition by metoclopramide may reduce activation of tramadol.
How serious is the interaction between Metoclopramide intranasal and Tramadol?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for seizures, extrapyramidal symptoms and signs of serotonin syndrome, and consider an alternative antiemetic or analgesic in patients with seizure risk. Reassess pain control if tramadol seems less effective.
What other medicines interact with Tramadol?
MediHelp also lists interactions of Tramadol with, for example, Isocarboxazid, Olanzapine / samidorphan, Phenelzine. The full list is on the Tramadol page.
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