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Metoclopramide

Also indexed as: Ocatmide®, Reglan®

Metoclopramide is used to treat heartburn and regurgitation; to prevent vomiting in people receiving drugs to treat cancer; and to prevent nausea, vomiting, heartburn, and fullness after a meal in certain individuals with diabetes.

Interactions with Dietary Supplements

N-acetyl cysteine
A single case report described a 15-year-old girl who suffered oxygen deprivation in her body tissues after being given high amounts of metoclopramide and N-acetyl-cysteine to treat her for an overdose of acetaminophen.1 It is unknown whether N-acetyl-cysteine supplementation in the absence of acetaminophen overdose could cause similar effects in people taking metoclopramide. Until controlled research determines the safety of this combination, it should be used only under the supervision of a qualified physician.

Interactions with Herbs

Willow (Salix alba)
Salicylic acid is a compound formed in the body from either aspirin or willow bark. Taking metoclopramide before aspirin or willow bark results in higher concentrations of salicylic acid and greater pain relief in people suffering from an acute migraine headache.2 Controlled studies are necessary to confirm the benefit of this interaction.

Interaction with Foods and Other Compounds –––

Lactose-containing foods
Individuals who have lactose intolerance (difficulty digesting milk sugar) may experience more severe symptoms while taking metoclopramide.3 Lactose is the milk sugar present in dairy products.

Caffeine
A single case report described a 42-year-old man taking metoclopramide who experienced mental depression after he abruptly quit using caffeine.4 People who are advised to quit caffeine should probably reduce their coffee or tea consumption gradually if they are taking metoclopramide.

Alcohol
Drinking alcohol while taking metoclopramide may significantly increase the amount and speed of alcohol absorption, resulting in enhanced alcohol effects such as drowsiness.5 Consequently, people taking metoclopramide should avoid alcohol, especially when staying alert is necessary.

Summary of Interactions for Metoclopramide

Depletion or interference None known
Adverse interaction N-acetyl cysteine*
Side effect reduction/prevention None known
Supportive interaction Willow*
Reduced drug absorption/bioavailability None known

For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

References:

1. Langford JS, Sheikh S. An adolescent case of sulfhemoglobinemia associated with high-dose metoclopramide and N-acetylcysteine. Ann Emerg Med 1999;34:538–41.

2. Miner JO. Drug interactions involving aspirin (acetylsalicylic acid) and salicylic acid. Clin Pharmacokinet 1989;17:327–44.

3. Peuhkuri K, Vapaatalo H, Nevala R, Korpela R. Influence of the pharmacological modification of gastric emptying on lactose digestion and gastrointestinal symptoms. Aliment Pharmacol Ther 1999;13:81–6.

4. Wenokur B, Lessem P. Caffeine withdrawal metoclopramide, and depression. Am J Gastroenterol 1993;88:1464 [letter].

5. Sifton DW, ed. Physicians Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 2603–5.