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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Brand Name
Amyl Nitrite
Generic Name
Amyl Nitrite
Active Ingredient
Amyl NitriteCategory
Standardized Insect Allergenic Extract [EPC]
Variants
1
Different strengths and dosage forms
| Strength | Form | Route | NDC |
|---|---|---|---|
| .3 g/.3mL | INHALANT | RESPIRATORY (INHALATION) | 46414-2222 |
Detailed information about Amyl Nitrite
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Amyl Nitrite, you must consult a qualified healthcare professional.
Amyl Nitrite is a potent nitrate vasodilator and emergency cyanide antidote. It functions by relaxing vascular smooth muscle and facilitating the conversion of hemoglobin to methemoglobin to neutralize cyanide ions.
Dosage of Amyl Nitrite must be strictly managed by medical professionals or administered according to emergency protocols.
In an emergency setting, the standard procedure involves the inhalation of one ampule (0.3 mL) for 30 seconds. This process is repeated every minute until the patient can be transitioned to intravenous sodium nitrite. A total of 3 to 4 ampules may be used in the initial stabilization phase. The goal is to produce a methemoglobin level of approximately 20% to 30%, which is sufficient to neutralize significant amounts of cyanide without causing life-threatening oxygen deprivation.
While rarely used today, the historical adult dose for acute angina is the inhalation of the vapors from one 0.3 mL ampule. The patient should remain seated or lying down during administration due to the high risk of sudden blood pressure drops (orthostatic hypotension). If symptoms do not resolve within 1 to 5 minutes, emergency medical attention is required, as the pain may indicate an evolving myocardial infarction (heart attack).
Amyl Nitrite is not routinely used in children except in life-threatening cyanide emergencies.
There is no standardized pediatric dose for inhalation; however, in emergency situations, healthcare providers may use the same 0.3 mL ampule but for shorter inhalation durations (e.g., 15 seconds instead of 30) to avoid excessive methemoglobinemia. Pediatric patients are significantly more sensitive to the induction of methemoglobinemia, and weight-based calculations for subsequent intravenous antidotes are mandatory.
Specific dosage adjustments for renal impairment are not typically defined for Amyl Nitrite because the drug is used for acute, emergency stabilization rather than chronic dosing. However, the clearance of nitrate metabolites may be slowed in patients with severe kidney disease, requiring careful monitoring of blood pressure.
As the liver is a primary site for the metabolism of nitrites to nitrates, patients with significant hepatic dysfunction may experience prolonged effects. Caution is advised, though the emergency nature of cyanide treatment usually takes precedence over hepatic considerations.
Geriatric patients are at a significantly higher risk for syncope (fainting) and severe hypotension. Healthcare providers typically use the lowest effective 'dose' (inhalation time) and ensure the patient is in a supine (lying flat) position to prevent falls and head injuries.
Amyl Nitrite is an inhalant and must never be swallowed or injected.
Since Amyl Nitrite is used only 'as needed' for acute symptoms or emergencies, there is no regular dosing schedule. If a dose is required but not administered during a cyanide emergency, the risk of fatality is high. For angina, if a dose is missed during an attack, the attack may persist or worsen.
Signs of Amyl Nitrite overdose include extreme dizziness, fainting, a 'throbbing' headache, blue-colored skin or lips (cyanosis), shortness of breath, and a rapid, weak pulse. These symptoms usually indicate severe hypotension or excessive methemoglobinemia.
In the event of an overdose:
> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose without medical guidance.
Amyl Nitrite is a potent vasodilator, and most side effects are a direct extension of its pharmacological action on blood vessels.
> Warning: Stop taking Amyl Nitrite and call your doctor immediately if you experience any of these.
Amyl Nitrite is not intended for long-term or chronic use. However, repeated exposure (often seen in occupational settings or through substance abuse) can lead to:
No FDA black box warnings currently exist for Amyl Nitrite. However, it is subject to strict regulatory oversight due to its potential for abuse and its high flammability. Healthcare providers emphasize that it should only be used for its intended clinical purposes under medical supervision.
Report any unusual symptoms to your healthcare provider. If you suspect an adverse reaction, you may also report it to the FDA at 1-800-FDA-1088.
Amyl Nitrite is a high-potency medication that requires careful handling. It is highly volatile and flammable. It should never be used near an open flame, and smoking is strictly prohibited during and immediately after administration. Because it causes a rapid and significant drop in blood pressure, it should always be administered while the patient is in a stable, reclining, or seated position to prevent falls.
No FDA black box warnings for Amyl Nitrite. However, the lack of a black box warning does not imply that the drug is without significant risks. Its use in the absence of a clear medical indication (such as suspected cyanide poisoning) is dangerous and potentially fatal.
In a clinical or emergency setting, the following monitoring is essential:
Patients should not drive or operate heavy machinery for several hours after receiving Amyl Nitrite. The drug causes significant dizziness, lightheadedness, and potential blurred vision, which severely impairs the ability to perform tasks requiring coordination and alertness.
Alcohol consumption is strictly contraindicated with Amyl Nitrite. Alcohol is also a vasodilator, and combining the two can lead to a catastrophic drop in blood pressure, resulting in cardiovascular collapse, profound fainting, and death.
As Amyl Nitrite is used for acute episodes, there is no tapering requirement for single-use emergency administration. However, individuals who have used nitrites chronically (such as in an occupational setting) should be monitored for 'rebound' effects, where blood vessels may constrict excessively upon withdrawal, potentially triggering angina.
> Important: Discuss all your medical conditions with your healthcare provider before starting Amyl Nitrite.
For each major interaction, the mechanism involves the cumulative effect on the cGMP pathway or the systemic vascular resistance. The clinical consequence is typically profound hypotension. Management strategies include withholding the drug if a contraindication exists or providing aggressive fluid resuscitation if an interaction occurs.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking.
Amyl Nitrite must NEVER be used in the following circumstances:
These conditions require a careful risk-benefit analysis by a physician:
Patients who are allergic to other nitrates, such as nitroglycerin, isosorbide mononitrate, or isosorbide dinitrate, are highly likely to be allergic to Amyl Nitrite. This 'class sensitivity' is a critical consideration for prescribing physicians.
> Important: Your healthcare provider will evaluate your complete medical history before prescribing Amyl Nitrite.
Amyl Nitrite is classified as FDA Pregnancy Category C. This means that animal reproduction studies have not been conducted, and it is not known whether Amyl Nitrite can cause fetal harm when administered to a pregnant woman. In the case of life-threatening cyanide poisoning, the benefit to the mother's life generally outweighs the potential risks to the fetus. However, for the treatment of angina, safer alternatives with better-established safety profiles are preferred. If used during pregnancy, the patient must be monitored for severe hypotension, which can reduce placental blood flow and cause fetal distress.
It is not known whether Amyl Nitrite or its metabolites are excreted in human milk. Because many drugs are excreted in milk and because of the potential for serious adverse reactions in nursing infants (such as methemoglobinemia), caution should be exercised. If Amyl Nitrite is administered in an emergency, breastfeeding should be temporarily suspended until the drug has been completely cleared from the mother's system (typically 24 hours).
Amyl Nitrite is not approved for routine use in children. Its use is strictly limited to emergency cyanide poisoning. Pediatric patients are more susceptible to the development of methemoglobinemia and severe hypotension. Dosing in children requires extreme precision and constant monitoring by a pediatric intensivist or toxicologist. It is not used for pediatric angina, as this condition is exceedingly rare in children and usually related to congenital defects requiring different management.
Clinical studies of Amyl Nitrite did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. However, clinical experience suggests that elderly patients are more prone to orthostatic hypotension and syncope. There is also a higher prevalence of polypharmacy in this age group, increasing the risk of drug interactions with antihypertensives or PDE5 inhibitors. Dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range.
While no specific dose adjustments are provided in the labeling, the kidneys are responsible for excreting the inorganic nitrate metabolites of Amyl Nitrite. In patients with end-stage renal disease (ESRD), these metabolites may accumulate. While the acute effects of the nitrite itself are short-lived, the secondary effects on blood pressure should be monitored closely in those with impaired kidney function.
As the liver is the primary site for the conversion of nitrites to nitrates, patients with severe hepatic impairment (Child-Pugh Class C) may experience a prolonged duration of action. These patients should be monitored for extended periods of hypotension following administration.
> Important: Special populations require individualized medical assessment.
Amyl Nitrite is a prodrug that acts as a source of nitric oxide (NO). Upon inhalation, the nitrite enters the systemic circulation and reacts with thiols in the vascular smooth muscle to form S-nitrosothiols, which then release nitric oxide. Nitric oxide activates soluble guanylate cyclase, increasing the production of cyclic guanosine monophosphate (cGMP). This second messenger activates cGMP-dependent protein kinases, leading to the dephosphorylation of the myosin light chain. This results in the relaxation of smooth muscle fibers in both arteries and veins.
In the context of cyanide poisoning, Amyl Nitrite acts as an oxidant. It reacts with the ferrous iron (Fe2+) in the heme group of hemoglobin to form methemoglobin (Fe3+). This methemoglobin then acts as a 'decoy' for cyanide ions, preventing them from binding to the cytochrome c oxidase in the mitochondria, thereby restoring cellular respiration.
The pharmacodynamic effect of Amyl Nitrite is almost immediate. Within 30 seconds of inhalation, systemic vascular resistance drops, and heart rate increases as a compensatory mechanism. The duration of the vasodilatory effect is short, typically lasting only 3 to 5 minutes. Tolerance to the effect can develop rapidly with repeated use (tachyphylaxis), a common characteristic of the organic nitrate class.
| Parameter | Value |
|---|---|
| Bioavailability | High (via inhalation) |
| Protein Binding | Minimal |
| Half-life | Approximately 1-2 minutes |
| Tmax | < 30 seconds |
| Metabolism | Hepatic and intravascular (to inorganic nitrates) |
| Excretion | Renal (as metabolites) |
Amyl Nitrite is a member of the organic nitrate/nitrite class. Related medications include nitroglycerin (sublingual and transdermal), isosorbide dinitrate, and isosorbide mononitrate. While all share the vasodilator mechanism, Amyl Nitrite is unique in its delivery method (inhalation) and its specific utility as a cyanide antidote.
Common questions about Amyl Nitrite
Amyl Nitrite is primarily used in modern medicine as an emergency treatment for cyanide poisoning. When someone inhales or ingests cyanide, Amyl Nitrite is used to quickly create methemoglobin in the blood, which binds to the cyanide and prevents it from damaging the cells. Historically, it was also used to treat acute chest pain (angina pectoris), though it has largely been replaced by nitroglycerin for this purpose. Additionally, it is sometimes used in specialized medical tests to help doctors hear heart murmurs more clearly. It is a potent medication that should only be administered in emergency situations or under strict medical supervision.
The most common side effect of Amyl Nitrite is a severe, throbbing headache, often referred to as a 'nitrate headache,' which is caused by the dilation of blood vessels in the brain. Patients also frequently experience flushing of the face and neck, dizziness, and a rapid heartbeat (tachycardia). Because it lowers blood pressure very quickly, many people feel lightheaded or faint immediately after inhaling the vapors. Most of these effects are short-lived because the drug is processed by the body very quickly. However, if these symptoms persist or become severe, it is important to seek medical attention immediately.
No, you should never drink alcohol while using Amyl Nitrite. Both alcohol and Amyl Nitrite act as vasodilators, meaning they both cause your blood vessels to relax and your blood pressure to drop. When used together, they can cause a dangerously low drop in blood pressure, leading to severe dizziness, fainting, or even cardiovascular collapse. This combination can be life-threatening and is a major safety concern. If you have consumed alcohol, you must inform emergency medical personnel before they administer any nitrate-based medication.
Amyl Nitrite is classified as a Category C medication, meaning its safety during pregnancy has not been fully established through clinical trials. In a life-threatening emergency like cyanide poisoning, the benefits of saving the mother's life usually outweigh the potential risks to the unborn baby. However, for non-emergency conditions like angina, healthcare providers will almost always choose a different medication with a better-known safety profile. If it must be used during pregnancy, doctors will closely monitor the mother's blood pressure to ensure the baby is still receiving enough oxygen and blood flow. Always discuss your pregnancy status with your healthcare team in any medical situation.
Amyl Nitrite is one of the fastest-acting medications available, with an onset of action typically occurring within 30 seconds of inhalation. This rapid onset is why it is so valuable in emergency cyanide kits, where every second counts to prevent cellular damage. The peak effect is reached almost immediately after inhalation. However, the effects are also very brief, usually lasting only between 3 and 5 minutes. Because the drug wears off so quickly, it is often used as a 'bridge' treatment until more long-lasting intravenous medications can be started by a doctor.
Since Amyl Nitrite is used only as an emergency or 'as-needed' treatment, there is no regular schedule to stop. It is not intended for daily or chronic use. However, for individuals who may have been exposed to it frequently in an industrial or occupational setting, stopping exposure suddenly can sometimes cause 'rebound' symptoms, such as chest pain or high blood pressure, as the blood vessels overcompensate for the lack of the drug. If you have been using any nitrate medication regularly, you should only stop or change your usage under the direct guidance of your healthcare provider to avoid these complications.
Amyl Nitrite does not have a standard dosing schedule; it is administered only when symptoms of angina occur or in the event of a cyanide emergency. Therefore, you cannot 'miss' a dose in the traditional sense. If you are experiencing chest pain and your doctor has prescribed Amyl Nitrite, you should use it exactly as instructed at the onset of the pain. If the pain does not go away after one dose, you must seek emergency medical help immediately. Do not try to 'make up' for a missed opportunity to treat an attack by using more of the drug later; only use it when symptoms are actually present.
There is no clinical evidence to suggest that Amyl Nitrite causes weight gain. Because the medication is used only for very short periods in emergency or acute situations, it does not have the opportunity to affect the body's metabolism or fat storage in a way that would lead to weight changes. If you are experiencing unexplained weight gain while being treated for a heart condition, it is more likely related to other medications, such as certain beta-blockers, or a sign of worsening heart failure (fluid retention). You should discuss any significant changes in your weight with your doctor immediately.
Amyl Nitrite has several very dangerous drug interactions, most notably with medications for erectile dysfunction like Viagra (sildenafil) or Cialis (tadalafil). Taking these together can cause a fatal drop in blood pressure. It can also interact with other blood pressure medications, antidepressants, and certain antipsychotics. Because of these risks, it is vital that you provide your healthcare provider with a complete list of all prescriptions, over-the-counter drugs, and herbal supplements you are taking. Never start a new medication while being treated with nitrates without first consulting your doctor or pharmacist to ensure it is safe.
Yes, Amyl Nitrite is available as a generic medication. It is typically sold in boxes of small glass ampules for inhalation. While the drug itself is relatively inexpensive, it is often packaged as part of a specialized 'Cyanide Antidote Kit,' which may include other medications like sodium nitrite and sodium thiosulfate. Because it is an older medication that has been used for over a century, there are no active patents protecting it, allowing multiple manufacturers to produce the generic version. However, it still requires a prescription and should only be used under medical supervision.
Other drugs with the same active ingredient (Amyl Nitrite)