Propranolol - B blocker that potentiates nitrite Antacids
There has been much debate about the advantage of lowering stomach acid (to lessen gastric nitric oxide production with associated blood pressure drop) and allowing more nitrite to be directly absorbed into the blood from the small intestine. However, the benefit or otherwise of taking an antacid (such as Mylanta), an H2 antagonist (like Cimetidine) or a proton pump inhibitor (such as Nexium) cannot be established. This is, therefore, no longer advised.
B-blockers
The lethality of nitrite can be enhanced by the concurrent use of a B-blocker such as propranolol. The propranolol interferes with the compensatory cardiac response to the effects of the nitrite- induced cerebral hypoxia With insufficient oxygen, the brain will attempt to compensate by increasing cardiac output. The B-blocker, however, will frustrate this attempted compensation by restricting cardiac output, and further aggravate the hypoxia.