Drug General Information (ID: DDIEKP582S)
Drug Name			Metoclopramide		Drug Info		Opium		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiemetics				Narcotic Analgesics

Mechanism of Metoclopramide-Opium Interaction (Severity Level: Moderate)
Additive CNS depression effects Click to Show/Hide Mechanism Graph
Drug Name		Metoclopramide				Opium
Mechanism 1		CNS depression effects				CNS depression effects
Key Mechanism Factor 1
		Factor Name		CNS depression effects
		Factor Description		CNS depressants are drugs that inhibit or suppress brain activity and can reduce mental and physical processes. Excessive CNS depression can lead to decreased heart rate, slow breathing (less than 10 breaths per minute), extreme confusion or loss of memory, nausea and vomiting, poor judgment, blue lips or fingertips, irritability and aggression, and clammy or cold skin.
Mechanism Description		Additive CNS depression effects by the combination of Metoclopramide and Opium
Antagonize the effect of prokinetic agents Click to Show/Hide Mechanism Graph
Drug Name		Metoclopramide				Opium
Mechanism 2		Increase gastrointestinal motility				Decrease gastrointestinal motility
Key Mechanism Factor 2
		Factor Name		Prokinetic agents
		Factor Description		The efficacy of prokinetic agents may be reduced, leading to delayed gastric emptying and worsening esophageal reflux.
Mechanism Description		Antagonize the effect of Metoclopramide when combined with Opium

Recommended Action
Management		The potential for reduced efficacy of gastrokinetic agents should be considered during coadministration with opioid analgesics. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their doctor if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References
1	Product Information. Reglan (metoclopramide). Wyeth-Ayerst Laboratories, Philadelphia, PA.
2	Manara AR, Shelly MP, Quinn K, Park GR "The effect of metoclopramide on the absorption of oral controlled release morphine." Br J Clin Pharmacol 25 (1988): 518-21. [PMID: 3382595]
3	Greiff JMC, Rowbotham D "Pharmacokinetic drug interactions with gastrointestinal motility modifying agents." Clin Pharmacokinet 27 (1994): 447-61. [PMID: 7882635]