Amyl nitrite

popper

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Amyl nitrite ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Amyl nitrite ballicule

What it isInhaled nitric oxide donor; historical use in angina and cyanide poisoning.

Why this oneActs within seconds by inhalation, which no oral nitrate matches.

What limits itMethemoglobinemia was the point in cyanide poisoning but is a hazard otherwise. Recreational use with PDE5 inhibitors causes fatal hypotension.

Amyl nitrite molecular structure (skeletal formula) — Molecular structure: Amyl nitrite

FDA-approved for

cyanide poisoning (historical)
angina (historical)

Principal riskMethemoglobinemia was the point in cyanide poisoning but is a hazard otherwise

Classes and tags

Clinical profile

Therapeutic safety burden1 / 4

Sedation liability0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

FDA label

Read the full label on DailyMed ↗

NO BOXED WARNINGS

FDA dosing	Population	Start	Target	Max
Rapid relief of angina pectoris	Adults	1 capsule (0.3 mL) crushed, 2–6 inhalations PRN	2–6 inhalations per dose	Undefined (may repeat in 3 to 5 min if necessary)

Renal Undefined

Hepatic Undefined

Effect within 30 seconds, lasts ~3 to 5 min; tolerance with prolonged repeated use

Instructions

Patient seated or lying down
Hold capsule away from face, crush between fingers, hold under patient's nose
Avoid inhaling excess vapor when given by someone else
Very flammable — keep away from open flame or sparks

Available strengths

inhaler 0.3 g/.3 mL

Contraindications

Glaucoma, recent head trauma, or cerebral hemorrhage (contraindicated or use with great caution — raises intraocular/intracranial pressure)
Pregnancy — can cause fetal harm (reduced maternal blood pressure and placental blood flow)

Cautions

Postural hypotension, dizziness, syncope
Flammable
Tolerance with prolonged use
Methemoglobinemia at high doses
Alcohol: severe hypotension/cardiovascular collapse

Adverse reactions

Headache (transitory)
Dizziness
Facial flushing
Syncope
Involuntary passing of urine/feces
Hypotension
Pallor
Cold sweat
Tachycardia
Restlessness
Weakness
Nausea/vomiting

Pregnancy Category C; label also lists fetal harm under Contraindications; give only if clearly needed

Lactation Unknown if excreted in human milk; use with caution

Cost

Amyl nitrite (POPPER)

Strength		#/mo	generic $/unit	CostPlus
0.3 g/.3 mL	inhaler	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Amyl nitrite is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

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Self-check

What combination with amyl nitrite can cause fatal hypotension?
PDE5 inhibitors.
What hemoglobin effect was intended in cyanide poisoning?
Methemoglobinemia.