Metoclopramide SSRIs

Chlorpromazine, prochlorperazine, promethazine, methylprednisolone, lorazepam, metoclopramide, dexamethasone, or dronabinol may be used for adult patients. Around the clock dosing should be considered. The choice of specific agent should based on patient specific factors, including potential for adverse drug reactions, and cost. SSRIs are effective for breakthrough nausea and vomiting but they are not superior to the less expensive antiemetics above. 

Aprepitant, dexamethasone, or metoclopramide have demonstrated efficacy in preventing CINV, whereas the results with SSRIs are inconsistent. 

Drugs that may affect cyclosporine include allopurinol, amiodarone, androgens (eg, danazol, methyltestosterone), anticonvulsants (eg, carbamazepine, phenobarbital, phenytoin), azole antifungals (eg, fluconazole, ketoconazole), beta-blockers, bosentan, bromocriptine, calcium channel blockers, colchicine, oral contraceptives, corticosteroids, fluoroquinolones (eg, ciprofloxacin), foscarnet, HMG-CoA reductase inhibitors, imipenem-cilastatin, macrolide antibiotics, methotrexate, metoclopramide, nafcillin, nefazodone, orlistat, potassium-sparing diuretics, probucol, rifamycins (rifampin, rifabutin), serotonin reuptake inhibitors (SSRIs eg, fluoxetine, sertraline),... 

Recommendation 4. For the prevention of delayed emesis after cisplatin therapy in adults, dexamethasone with metoclopramide or a SSRI is recommended. Thechoice of agent should be based on patient-specific factors and cost. For delayed emesis after cyclophosphamide, doxorubicin, or carboplatin therapy, a SSRI with dexamethasone is recommended. In pediatric patients, chlorpromazine, lorazepam, or a SSRI can be used in combination with a corticosteroid. 

A regional pharmacovigilance centre in France reported 37 eases of extrapyramidal adverse effects linked to concurrent use of an SSRI and a neuroleptic (said to be metoclopramide in 4 cases). ... 

Both SSRIs and metoclopramide can cause extrapyramidal reactions metoclopramide by blocking dopamine D2 receptors in the basal ganglia, and SSRIs by inhibition of dopamine neurotransmission. Metoclopramide has also been reported to have intermediate affinity to certain serotonin receptors. ... 

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