Is it safe to take Meclizine (meclizine) and Reglan (metoclopramide) at the same time?

Concurrent Use of Meclizine and Metoclopramide (Reglan)

Yes, meclizine and metoclopramide can be safely used together, and this combination is specifically supported in clinical guidelines for managing nausea and vomiting, particularly when emergency contraception is needed. 1

Evidence for Concurrent Use

The most direct evidence comes from the CDC's 2024 contraceptive guidelines, which explicitly studied this combination:

• Meclizine taken before metoclopramide significantly reduces nausea and vomiting when both drugs are used together for emergency contraception protocols 1
• Two clinical trials specifically evaluated antiemetic pretreatment (meclizine and metoclopramide) and found that meclizine reduced both the severity of nausea AND the occurrence of vomiting when given before combined hormonal emergency contraceptives 1

Complementary Mechanisms of Action

These medications work through different pathways, making their combination logical:

• Meclizine is an antihistamine that blocks H1 receptors centrally, providing antiemetic effects primarily through the vestibular system and chemoreceptor trigger zone 2, 3
• Metoclopramide (Reglan) is a dopamine antagonist that works both centrally at the chemoreceptor trigger zone AND peripherally by increasing gastric emptying and lower esophageal sphincter tone 4, 5

Clinical Applications Where This Combination Is Useful

For Nausea/Vomiting Prevention

• Pretreat with meclizine 25-50 mg, then give metoclopramide 10 mg when anticipating significant nausea risk 1, 6
• This approach is particularly effective for medication-induced nausea (such as emergency contraceptives or chemotherapy-related nausea) 1

For Hiccups

• Metoclopramide 10 mg three to four times daily can be used as primary therapy 7
• Meclizine could theoretically be added for concurrent nausea, though guidelines don't specifically address this combination for hiccups 7, 8

Important Safety Considerations

Sedation Risk

• Both medications cause drowsiness and sedation - this is the primary concern with concurrent use 4, 5, 3
• Meclizine causes sleepiness, tiredness, and concentration problems 3
• Metoclopramide causes drowsiness and lassitude in up to 20% of patients 5
• Warn patients about additive sedation and avoid driving or operating machinery 3

Metoclopramide-Specific Warnings

• Limit metoclopramide duration to short-term use (days to weeks, not months) due to risk of tardive dyskinesia with prolonged use 7, 8
• Monitor for extrapyramidal symptoms including dystonic reactions, akathisia, and muscle rigidity 7, 5
• Use caution in patients with seizure disorders, GI bleeding, or GI obstruction 8
• Consider having diphenhydramine available to treat potential dystonic reactions from metoclopramide 7

Meclizine-Specific Considerations

• Meclizine has a slower onset (approximately 1 hour) compared to IV metoclopramide 2
• Common side effects include blurred vision and dizziness in addition to sedation 3

Practical Dosing Approach

For acute nausea/vomiting:

• Meclizine 25-50 mg orally 30-60 minutes before metoclopramide 1, 6
• Metoclopramide 10 mg orally or IV as needed 7

For ongoing symptoms:

• Metoclopramide 10 mg three to four times daily (primary agent) 7
• Meclizine 25-50 mg once or twice daily as adjunct for breakthrough nausea 6

When to Avoid This Combination

• Patients requiring alertness for work or driving (due to additive sedation) 3
• Elderly patients at higher risk for falls and cognitive impairment 8
• Patients with pre-existing movement disorders (metoclopramide contraindication) 8
• When metoclopramide has already been used long-term (>12 weeks) due to tardive dyskinesia risk 8