By Anthony McDaniel, M.D.
Amyl nitrite is the chemical compound with the formula C5H11ONO. A variety of isomers are known, but they all feature an amyl group attached to the nitrito functional group. The alkyl group is unreactive and the chemical and biological properties are mainly due to the nitrite group. Like other alkyl nitrites, amyl nitrite is bioactive in mammals, being a vasodilator, which is the basis of its use as a prescription medicine. As an inhalant, it also has a psychoactive effect, which has led to its recreational use. Poppers is a slang term for various alkyl nitrites inhaled for recreational purposes, particularly amyl nitrite, butyl nitrite, isopropyl nitrite and isobutyl nitrite. Amyl nitrite is used medically as an antidote to cyanide poisoning, but the term "poppers" refers specifically to recreational use. Amyl nitrite and several other alkyl nitrites, which are present in products such as air freshener and video head cleaner are often inhaled with the goal of enhancing sexual pleasure. These products have also been part of the club culture from the 1970s disco scene to the 1980s and 1990s rave scene. Poppers have a long history of use due to the rush of warm sensations and dizziness experienced when the vapours are inhaled.
Although, according to at least one analysis, poppers have a lower risk of harm to society and the individual than do certain other recreational drugs, other cases have shown that serious adverse effects can occur. In a letter to the New England Journal of Medicine, an ophthalmologist described four cases in which recreational users of poppers experienced temporary changes in vision. There is some evidence to indicate that even occasional use of poppers may affect vision. With heavy long-term use there is a potential for neurological damage. Accidentally swallowing or aspirating the liquid, rather than inhaling the vapors, is certainly dangerous and can prove fatal.
More rarely, acute use of poppers has been associated with asphyxia, arrhythmias, cardiovascular depression, carbon monoxide poisoning, hepatorenal toxicity, methemoglobinemia, neurologic dysfunction, mucosal, pulmonary, skin irritation and facial dermatitis. With chronic use neurological damage may occur. Rarely, the use of poppers can cause methemoglobinemia and hemolysis, especially in individuals predisposed towards such a condition or in overdose. An overdose via ingestion (rather than inhalation) may result in cyanosis, unconsciousness, coma and even death. Methylene blue is a treatment for methemoglobinemia associated with popper use. Accidental aspiration of amyl or butyl nitrites may lead to the development of lipoid pneumonia. Poppers can interact with prescription vasodilators, such as sildenafil (Viagra), to cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack.
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