The Drug-Induced Respiratory Disease Website and App

Amyl-nitrite, butyl-nitrite, isobutyl-nitrite ('Poppers')

Nitrites are used as sexual enhancers by 'Poppers'. Main AE is methemoglobinemia, a life-threatening condition. Methemoglobinemia is suggested in the patient with slate-grey cyanosis that does not improve with oxygen therapy, low or spurious SpO2, normal measured PaO2, and chocolate-brown arterial blood that does not turn bright red when agitated in air or bubbled with oxygen. Oxygen therapy and methylene blue are treatment options. Hyperbaic oxygen therapy is reserved for severe or recalcitrant cases. There is a huge list of causal drugs in addition to inhaled nitrites (see under XIV: Acquired Hemoglobinopathies)

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic