Urgent: should metoclopramide (Reglan) & Cerenia ever be given together?

One vet prescribed metoclopramide (Reglan) - mostly for nausea / some motility @ 1/2 tab (2.5mg), 3 - 4x/D.
Wasn't helping vomiting much w/ CKD - late stage.

Vet 2 prescribed cerenia - 8mg/D & mirtazapine - appetite stim. @ 3.75mg, every OTHER day.
Vet 2 said continue Reglan - reduce to 1.25 mg (1/4 tab), every 8 hrs. Mal began holding MUCH more food down (syringe).

Mal is / has been (more) lethargic & drowsy since the day he started cerenia. After starting cerenia & other 2 drugs (started last Sat. 6/4), was noticeably less active - still moved around & at least swallowed food (slowely), once syringed in his mouth.

Today, he's much more lethargic & really didn't want to swallow food (but did so slowly). Got ~ 33 ml canned & phosphate binder, some B-complex, etc, in him this morning. Pupils are not very reactive to direct light (moderately reactive).
I don't know if it's the drugs combined (in some cases, these symptoms could well be combined drugs - cats or human). Even a mild stroke?

I've begun extra SQ LRS fluids - besides daily 125ml. Skin showed some dehydration signs; gums not dry or extremely tacky. Last gave ~ 25 ml an hr ago ~ 1PM our time.
Can also give some oral water - if he'll swallow.

Or, if Mal's near the end? I can call the vet, but it'll take a while for reply. Anyway, wanted other opinions.

He has a mild heart murmur - vet 2 mentioned. I listened today - can hear it, but heartbeat sounds strong & fairly normal, except for the occasional skip.
Breathing isn't extremely labored (not gasping, nor so shallow that it's barely noticeable).

Hi CatOMight.

I checked Plumbs Vet Drug Handbook and found no cautions against using Reglan & Cerenia together.

Same (obviously) in the CKD 'Oracle'......links below.

HOWEVER....there is a caution highlighted in Tanya's site that concurrent use of the appetite stimulant Mirtazapine and Reglan increases the risk of serotonin syndrome. Here's that link (see Side Effects and Interactions)  http://www.felinecrf.org/nausea_vomiting_stomach_acid.htm#metoclopramide    There's a link inside there for a fuller description of serotonin syndrome ( http://www.felinecrf.org/persuading_cat_to_eat.htm#serotonin_syndrome   )

Reglan coverage:  http://www.felinecrf.org/nausea_vomiting_stomach_acid.htm#metoclopramide

Cerenia coverage: http://www.felinecrf.org/nausea_vomiting_stomach_acid.htm#maropitant

Have you considered joining Tanya's online group?  I participated in it several years ago for a learning experience and found it to be very helpful with the nitty-gritties of CKD. One major advantage is the cluster of caregivers in one location 24/7. ( https://tanyackd.groups.io/g/support   )

Hope that helps.

(can't believe this didn't go thru 2 days ago - sorry. It's a moot point now, but response was appreciated)

Thanks for info links. Most I've seen, but needed reminding.
Yes, I'm member of tanyackd.org. No answers so far on this topic. When it comes to really technical issues, it's hard to get answers anywhere - it's complicated & even vets / MDs, pharmacists get confused, make mistakes, don't have right answers about meds. There've been several Rx prescribing / filling mistakes, just in my immediate family.

Vet (2) called back. They, like so many owners' comments I've read for yrs, suggest euthanasia, or putting him in their hospital. Only options that seem to profit them. Would not / did not address Reglan & Cerenia together. Wouldn't give a range of SQ volumes to give. Side stepped them like slick politician, but said (quoting), "but we'll do anything we can to help you." Mal MAY well die - no doubt. If he's absolutely destined to die, no matter what, as the vet said, why pay the many hundreds - likely 1000(s) - as vet suggested, "putting him in (our) hospital so we can monitor him & adjust fluids?"

What they're failing to consider is
1) he only had 3 wks of proper fluid therapy (vet #1 dragging feet) & his creatinine dropped a lot. When I mention that, again they side stepped it. Not sure why.
2). Lot of cats make turn arounds, but he may be near death.
3) Mixing Meds is often very unpredictable. I've experienced it a few times - where "very low side effect meds" literally made me think I was seriously ill. I couldn't figure it out, until realized it started right after the new med. Call the doctors - usually dismissed the notion. Often when I stopped the new meds, symptoms went away.

** Has anyone ever had a vet prescribe specific meds / supplements for anemia, other than B vitamins?
Vet 2 says he's anemic - I don't disagree - it's a new development. Mal now shows pale gums, slow capillary refill. Part of it ? could be from days of vomiting, when vet 1 refused to prescribe anything different. Or progressing disease - CKD or the undiagnosed "mass" between bladder & colon. I started him on a good Jarrow B-complex a while ago (one treatment for anemia), but it may be too little, too late.

His "PCV" tested 15% on 6/3 - very low; almost too low. Vet 2 mention anemia, but didn't suggest ANY treatment for. The opposite - made condescending comments in notes about "then owner started asking about B vit or cisapride" - like it was a bad thing to be concerned.
PCV wasn't tested on 4/28 test, but his RBC, WBC & HTC were OK on 4/28.
I haven't studied this aspect. http://vetgirlontherun.com/veterinary-continuing-education-pcv-tp-big4-vetgirl-blog/ says, "normal PCV is approximately 35% - 45%."
"A more common clinical problem - at least in the veterinary ER or ICU - is the dilemna of determining why the patient is anemic (e.g., low PCV)."

In CKD - there are several causes of anemia. Lack of producing red blood cells - caused by the disease itself.
PCV - packed cell volume is one way to diagnose http://www.felinecrf.org/anaemia.htm#pcv

Then, Reticulocytes: Deciding if it is Regenerative or Non-Regenerative Anaemia http://www.felinecrf.org/anaemia.htm#retics

His "PCV" tested 15% on 6/3 - very low; almost too low. That wasn't tested on 4/28, but his RBC & WBC were OK on 4/28.
I haven't studied this aspect. http://vetgirlontherun.com/veterinary-continuing-education-pcv-tp-big4-vetgirl-blog/ says, "normal PCV is approximately 35% - 45%."
"A more common clinical problem - at least in the veterinary ER or ICU - is the dilemna of determining why the patient is anemic (e.g., low PCV).

So, this latest vet couldn't give me a "good value" for continued Ringer's solution - whether 1x/D and / or small doses in addition. He was getting 125 ml /D & Vet 2 was fine w/ that.
However, his skin turgor test (scruff) now shows some dehydration, where as showed none a week before - tested by vet.