Resource Why antacids for SN are useless if metoclopramide or domperidone is used

[well2hell]

The September 2022 update of the PPeH removed the recommendation of using an antacid when taking sodium nitrite (SN). In the April 2022 edition, the basis for this recommendation was "reducing the amount of gastric acid in the stomach":

A reliable death is dependant on the nitrite overwhelming the restorative enzyme methemoglobin reductase. To achieve this, rapid gut absorption of the salt on ingestion is needed. This can be facilitated by fasting for several hours before taking nitrite, and by reducing the amount of gastric acid in the stomach.


The simplest way this can be achieved is by the use of a simple antacid such as Mylanta, but there is also some concern that the coating of the gastric surface may impede absorption.


A better method is to use a pre-dose of the H2 antagonist cimetidine to increase absorption of the nitrite (eg. Tagamet, 800mg, taken 40 minutes before the nitrite). This can be taken at the same time as the suggested anti-emetic ( metoclopramide with ondansetron).

However, this is useless when taking metoclopramide or domperidone because these two medications are not only antiemetics (medication that prevents nausea and vomiting) but also prokinetics (medication that accelerate stomach emptying). The prokinetic effect will reduce gastric fluid volume by itself and adding another antacid does not reduce it further.

This is well established in the medical literature, because removing gastric fluid prior to surgery is essential to avoid that it be aspirated into the lungs and causes pneumonia. Here are the results of a few clinical trials on patients undergoing surgery who were fasted (as one should be when taking SN); note that combining an antacid with metoclopramide is not more effective:

Metoclopramide and cimetidine to reduce gastric fluid pH and volume - PubMed

Eighty female patients undergoing outpatient laparoscopy were divided into four equal groups to investigate the effect of cimetidine and metoclopramide on the gastric fluid volume and pH. Group I patients received two placebo tablets. Group II patients were given metoclopramide, 10 mg, and one...

pubmed.ncbi.nlm.nih.gov

The effects of intravenous cimetidine and metoclopramide on gastric pH and volume in outpatients - PubMed

The combination of cimetidine and metoclopramide given to ambulatory patients during the preinductive phase may prevent severe pulmonary consequences should aspiration occur and is more effective in this regard than cimetidine alone.

pubmed.ncbi.nlm.nih.gov

Premedication with cimetidine and metoclopramide. Effect on the risk factors of acid aspiration - PubMed

A randomised, double-blind, placebo-controlled parallel study was conducted in adult females to evaluate the efficacy and safety of a combination of cimetidine 300 mg orally and metoclopramide 10 or 20 mg intravenously in reducing pre-operative residual gastric volume and raising gastric pH. The...

pubmed.ncbi.nlm.nih.gov

Effect of metoclopramide on gastric fluid volumes in diabetic patients who have fasted before elective surgery - PubMed

In elective surgical patients who have fasted before surgery, gastric volumes are minimal, even in diabetics with severe neuropathic symptoms. Metoclopramide prophylaxis to reduce gastric volumes seems to be unnecessary unless the patient has a prolonged history of poor blood glucose control.

pubmed.ncbi.nlm.nih.gov

It also seems that contrary to H2 antagonists like cimetidine, metoclopramide does not reduce gastric fluid pH, which was raised as a concern on the Suicide Wiki when using an antacid with SN.

Overall, there is no reason to take an antacid on top of a prokinetic antiemetic (metoclopramide, domperidone) because the latter already achieves the desired effect.

 

[Rounded Agony]

Thanks for yet more interesting posts. This one slipped away from me. Haven't time now to read the articles but will check out later. Save s me one more drug to shove into my system!

 

[thebookofdisquiet.]

Up!! Removing famotidine from my regimen.

 

[Meditation guide]

Up!! Removing famotidine from my regimen.

I'm using famotidine and not meto because meto seems risky to me due to the side effects. I love famotidine when I get a stomach ache, which I do when I eat eggs or certain other foods I'm sensitive to.

 

[thebookofdisquiet.]

I'm using famotidine and not meto because meto seems risky to me due to the side effects. I love famotidine when I get a stomach ache, which I do when I eat eggs or certain other foods I'm sensitive to.

Yeah, I use meto daily and the side effects aren't nice. Do you plan on using any antiemetic tho?

 

[Meditation guide]

Yeah, I use meto daily and the side effects aren't nice. Do you plan on using any antiemetic tho?

No, famotidine and prilosec which is an acid blocker, and I may start that one a few days before. I
want to have as little acid in my stomach as possible since hopefully it helps reduce the risk of stomach pain and headache. When SN mixes with acid such as stomach acid it creates a gas which causes the headache. Also I will take propranolol but not much of that, maybe only 100 mg.

People seem to vomit anyway even if they took an antiemetic so I'm not sure why to take one. Everyone says it speeds gastric emptying but on an empty stomach I think the SN is going to empty to the small intestine quickly enough.

 

[Meditation guide]

I think I will just use either famotidine or cimetodine, they are probably about the same. I think you need a prescription for cimetodine.

 

[Deleted member 65988]

Hmm, it's a good thing I have Meto

 

[Dying Knight]

I'm using famotidine and not meto because meto seems risky to me due to the side effects. I love famotidine when I get a stomach ache, which I do when I eat eggs or certain other foods I'm sensitive to.

According to several sources, PPIs are generally more effective than H2 blockers at reducing HCl.

Quote:
"In general, PPIs like rabeprazole are used first because they are better than H2 blockers at reducing stomach acid. However, if a PPI does not suit you (for example, because of side effects), your doctor may prescribe an H2 blocker"

Common questions about rabeprazole

www.nhs.uk

 

[Jezzibell]

Yeah, I use meto daily and the side effects aren't nice. Do you plan on using any antiemetic tho?

I honestly don't know what you are talking about.

I've alternated between domperidone and meto for 30 years now. As a women it can make you lactate.

People are over thinking. Every night I take 4xsachets of mag citrate, one effervescent mag potassium and mag chloride flakes. It helps for me to add I sachet of enos for heartburn. It helps otherwise I have reflux. I drink in less than 50ml water

It'll help to make the sn easier to take and there is no harm. Why not?

 

[i.was.lonely]

The September 2022 update of the PPeH removed the recommendation of using an antacid when taking sodium nitrite (SN). In the April 2022 edition, the basis for this recommendation was "reducing the amount of gastric acid in the stomach":



However, this is useless when taking metoclopramide or domperidone because these two medications are not only antiemetics (medication that prevents nausea and vomiting) but also prokinetics (medication that accelerate stomach emptying). The prokinetic effect will reduce gastric fluid volume by itself and adding another antacid does not reduce it further.

This is well established in the medical literature, because removing gastric fluid prior to surgery is essential to avoid that it be aspirated into the lungs and causes pneumonia. Here are the results of a few clinical trials on patients undergoing surgery who were fasted (as one should be when taking SN); note that combining an antacid with metoclopramide is not more effective:

Metoclopramide and cimetidine to reduce gastric fluid pH and volume - PubMed

Eighty female patients undergoing outpatient laparoscopy were divided into four equal groups to investigate the effect of cimetidine and metoclopramide on the gastric fluid volume and pH. Group I patients received two placebo tablets. Group II patients were given metoclopramide, 10 mg, and one...

pubmed.ncbi.nlm.nih.gov

The effects of intravenous cimetidine and metoclopramide on gastric pH and volume in outpatients - PubMed

The combination of cimetidine and metoclopramide given to ambulatory patients during the preinductive phase may prevent severe pulmonary consequences should aspiration occur and is more effective in this regard than cimetidine alone.

pubmed.ncbi.nlm.nih.gov

Premedication with cimetidine and metoclopramide. Effect on the risk factors of acid aspiration - PubMed

A randomised, double-blind, placebo-controlled parallel study was conducted in adult females to evaluate the efficacy and safety of a combination of cimetidine 300 mg orally and metoclopramide 10 or 20 mg intravenously in reducing pre-operative residual gastric volume and raising gastric pH. The...

pubmed.ncbi.nlm.nih.gov

Effect of metoclopramide on gastric fluid volumes in diabetic patients who have fasted before elective surgery - PubMed

In elective surgical patients who have fasted before surgery, gastric volumes are minimal, even in diabetics with severe neuropathic symptoms. Metoclopramide prophylaxis to reduce gastric volumes seems to be unnecessary unless the patient has a prolonged history of poor blood glucose control.

pubmed.ncbi.nlm.nih.gov

It also seems that contrary to H2 antagonists like cimetidine, metoclopramide does not reduce gastric fluid pH, which was raised as a concern on the Suicide Wiki when using an antacid with SN.

Overall, there is no reason to take an antacid on top of a prokinetic antiemetic (metoclopramide, domperidone) because the latter already achieves the desired effect.

i know my post isn't about antacids, but i still need help!
i'm planning to use the SN method with an otc sedative (for anxiety; i'm using Doxylamine from the brand Unisom), but i'm missing a dopamine antagonist antiemetic. i know there are otc antiemetics like pepto-bismol, but those aren't the right kind (dopamine antagonists). idk what to do — i can't get a prescription for anything. any advice?

 

[Deleted member 65988]

i know my post isn't about antacids, but i still need help!
i'm planning to use the SN method with an otc sedative (for anxiety; i'm using Doxylamine from the brand Unisom), but i'm missing a dopamine antagonist antiemetic. i know there are otc antiemetics like pepto-bismol, but those aren't the right kind (dopamine antagonists). idk what to do — i can't get a prescription for anything. any advice?

Bottom line: Use what you can even if it isn't prescription.

 

[G50]

According to this post, the reason that some people who try the sodium nitrite (SN) method experience excruciating stomach pain is because the HCl stomach acid converts SN into NaCl salt, and this results in pain.

So the suggestion is to take an antacid with the SN to prevent this.