Amyl Nitrite (Inhalation)

As an inhalant, amyl nitrite is used by patients around the world to quickly and efficiently combat the pain associated with angina attacks.

Overview

Amyl nitrite functions by helping to relax the blood vessels, which increases the flow of blood and oxygen to the heart while simultaneously reducing its workload. It is used medically to treat angina, and is also useful as an antidote to cyanide poisoning.

It is a very potent vasolidator, which causes an instant decrease in blood pressure, along with flushing of the face, dizziness, relaxation of the muscles and an increased heart rate. It is often used recreationally, as inhalation of the drug induces a brief, euphoric high, which is prolonged or intensified when combined with other stimulants or intoxicants.

The compound is created via the reaction of nitrous acid with alcohols, in a process known as esterification. The synthesis of amyl nitrite is quite straightforward, with the most common procedures involving the addition of sulfuric acid to a cooled-down mixture of an alcohol and an aqueous sodium nitrite solution. Because it is relatively easy to synthesise, amyl nitrite is regarded as an affordable means of treating heart issues.

Conditions treated

  • Angina
  • Heart problems
  • Cyanide poisoning

Type of medicine

  • Nitrate

Side effects

Along with the desired effects, some medicines can also produce unwanted side effects in the body. Some of the most common side effects associated with amyl nitrite use include headaches, flushing in the face, fainting, light headedness, involuntary defecation or urination, vomiting, nausea, low blood pressure, cold sweats, pale skin, increased heart rate, shortness of breath, restlessness and slow breathing.

In some medicines, side effects subside as the body adjusts to the drug. However, the side effects associated with amyl nitrite are often a direct effect or a by-product of the desired effects, and the patient is likely to experience them every time they use the medication. If any side effects are bothersome or cause severe discomfort, the patient is advised to contact their doctor or healthcare professional to discuss alternative treatments.

As well as treating angina, amyl nitrite also creates a 'head rush' style, short-lived euphoric high, which can last for anything between 30 seconds and two minutes. It is abused recreationally by some drug users. Please not that qualified health professionals do not advocate the use of amyl nitrite for recreational purposes, and insist that it should only be used as prescribed by those with legitimate health problems.

Those who take the medication frequently over a prolonged period of time may development a rash around the nose or mouth, along with irritation of the throat and nose. This is because the chemical has a propensity to cause burns on exposed skin.

In some instances, patients have reported a side effect of increased sexual pleasure when using amyl nitrite, specifically that it can make an orgasm feel like it is lasting longer. Some male patients have also reported that it can make an erection feel stronger.

Other side effects may not be listed, but may rarely occur in some patients. If a patient notices any other unwanted side effects, they are advised to check with a healthcare professional or contact the FDA for consumer advice.

Dosage

As with all medical treatments, it is incredibly important to only inhale amyl nitrite as directed by a physician. This means that patients should not take any more of the drug than advised, in terms of dosage and frequency of the dose. On top of this, patients who are advised to stop taking the medication on the advice of a doctor should do so immediately, even if they still have a supply of amyl nitrite remaining.

Doses of amyl nitrite will differ from patient to patient, depending on physiology, the condition being treated and the level of the condition. When taking this medicine, it is important to follow the advice of a doctor, or the advice as printed on the label distributed with the medication. Do not adjust your dose unless your doctor permits you to do so.

Amyl nitrite is available in a number of strengths, so doses may vary depending on the potency of the medicine. The number of doses taken each day and the length of time between doses may vary. For some illnesses, like angina, a doctor may advise that the drug should be taken as and when required, during an angina attack.

As an inhalant, adults will typically take a dose of 0.3ml (1 ampule), taken by inhaling the amyl nitrite vapor through the nose, which may be repeated within two to five minutes if the pain associated with angina is not yet relieved. If chest pain continues after numerous doses within a ten-minute period, patients are advised to contact their physician or arrange for someone to take them to a hospital emergency ward without any delay.

Because the patient may become dizzy or faint-headed when undergoing treatment with amyl nitrite, they are advised to sit down while the drug is administered. Following successful treatment, patients should take numerous deep breaths of air and sit leaning forward with their head between their knees until the faintness dissipates. If required, patients may also lie down with their feet in an elevated position until their condition improves.

For use as an antidote to cyanide poisoning, a 0.3ml ampule should be crushed, poured onto a gauze and held in front of the patient's mouth or endotracheal tubing (if the patient is currently intubated). The patient should be allowed to inhale the amyl nitrite over a period of up to 30 seconds, repeated until an intravenous sodium nitrite has been prepared. Each ampule lasts less than three minutes, and at least 30 seconds per ampule should be allowed to provide the patient with a period to oxygenate adequately.

Patients are warned against taking multiple doses. If a patient misses a dose, or if a single dose is not effective in reducing pain associated with angina, the patient should consider medical help.

There is no recommended amyl nitrite dose for those below the age of 18. In the instance of a minor requiring treatment with amyl nitrite, the dose should be decided upon by a qualified healthcare professional, who will be able to make the required adjustments in order to ensure treatment is effective at a smaller dosage.

Patients who experience signs or symptoms of overdose, which can include a fast pulse, headache, dizziness or light-headedness and blue lips, should contact the emergency services on 911 as soon as possible, or make their way to their local emergency department.

Interactions

Some drugs have the potential to react with other chemicals or drugs within the human body, and this can mean that the effects of one or more medicines can be changed as a result. This can lead to medicines being rendered ineffective in the treatment of a condition, or can even cause a dangerous reaction in the patient. For these reasons, it is imperative that patients keep a detailed list of any medications they are currently taking, including the dosage and frequency of each dose. This applies to prescription medicines, as well as over the counter treatments, herbal supplements and vitamins.

Below is a list of medications known to have interacted negatively with amyl nitrite. If the patient is currently undergoing treatment with one or more of these medicines, they should notify their doctor or physician before taking a dose of amyl nitrite:

  • Tadalafil
  • Avanafil
  • Adempas
  • Lidocaine
  • Emla
  • Epinephrine
  • Levaset
  • Oraqix
  • Prikaan
  • Ravatio
  • Sildenafil
  • Sodium nitrite
  • Tizanidine
  • Vardenafil

Amyl nitrites should never be taken in conjunction with erectile dysfunction medications, such as Viagra. When combined, the propensity for blood pressure rates to drop exponentially (hypotension) is greatly increased, and this can lead to potentially fatal cardiovascular collapse. The risk of other side effects is also increased, as is the potential for priapism (a prolonged, painful erection, which can permanently damage the penis). Patients who have recently taken erectile dysfunction medication are, therefore, advised to abstain from amyl nitrite use for at least 48 hours.

Patients who are currently undergoing treatment for severe anemia are advised to take caution when using amyl nitrite, as side effects may be increased. It is important to seek advice from a qualified healthcare professional under these circumstances.

Those who are prescribed amyl nitrite for the treatment of angina should also avoid alcohol. Because alcohol is a depressant, when used in conjunction with amyl nitrite, it can cause a severe drop in blood pressure, along with fainting or dizziness.

Warnings

In addition to making the doctor aware of a list of drugs currently being taken, patients are also encouraged to make healthcare professionals aware of any allergies they suffer from, along with their medical history and current issues or problems. In some instances, doctors may issue advice or warnings regarding amyl nitrite use if the patient is suffering from another condition; for example, com/health/coma/">glaucoma can be worsened by prolonged use of nitrites. Patients who suffer from the following problems should also inform their doctor prior to taking amyl nitrite:

  • Overactive thyroid
  • Stroke
  • Heart attack
  • Head injuries

Before using amyl nitrite, the risks associated with taking the medicine should be weighed up against the potential positive effects. This is a decision both patient and doctor will have to come to an agreement on.

In older people, dizziness and light-headedness is more likely to occur, so great care should be taken by those of advancing age when using amyl nitrite. A doctor may consider prescribed less acute treatments in certain circumstances.

Studies have not been undertaken to ascertain whether amyl nitrite causes any adverse effects in pregnant women. It is therefore classified in Pregnancy Category C by the FDA. Likewise, there is no evidence either way to suggest that amyl nitrite use may affect the quality of breastmilk in nursing mothers, who are advised to weigh up any potential benefits of the drug before breastfeeding.

Storage

Amyl nitrite should be stored at room temperature in a dry place, away from excess moisture heat and direct light. The solution should not be frozen, and it should be kept well out of the reach of children.

This substance is highly flammable, and should be kept away from any naked or open flame, especially when crushing and inhaling from the capsule.

Summary

Amyl nitrite is a popular, affordable means of treating angina. Although it can cause some unpleasant side effects, the benefits of alleviating pain associated with heart conditions generally outweighs the light-headedness observed by some.

In some instances, users actually enjoy the euphoric 'rush', and are happy to continue taking amyl nitrite to treat angina. However, its recreational effects mean that there is a potential for patients to abuse the drug. Patients who feel they are developing an addiction should contact their physician for advice.

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Last Reviewed:
December 23, 2017
Last Updated:
April 04, 2018