Amyl nitrite reduces left ventricular function, relaxes the smooth muscle of the arteries, lowers arterial blood pressure, and lowers myocardial oxygen consumption. Patients with cyanide poisoning are treated with it, and it is also used to provoke the LVOT gradient during echocardiography in those with hypertrophic cardiomyopathy. Because it produces a quick high and enhances sexual performance, it is overused.

Amyl Nitrite Dose in Adults

Dose as off-label use in the treatment of Cyanide toxicity:

• if the patient is intubated, insert a 0.3 mL ampule crushed onto a gauze pad in front of their mouth or endotracheal tube and allow them to breathe in slowly for 15 to 30 seconds.
• Until sodium nitrite can be delivered, the dose may be repeated every minute.
• Amyl nitrite is a temporary intervention that is used in prehospital settings, or if intravenous access is difficult, and until intravenous hydroxocobalamin or sodium nitrite and sodium thiosulfate infusions can be administered.

Dose as an off-label application in the treatment of hypertrophic cardiomyopathy with pharmacologic stimulation of the LVOT gradient:

• 3 - 4 deep inhalations from one crushed ampule over a 10 - 15 second period
• The use of physiologic testing like the Valsalva manoeuvre and treadmill testing with Doppler echocardiography are preferred over amyl nitrite.

Amyl Nitrite Dose in Children

Dose in the treatment of Cyanide toxicity:

• if the patient is intubated, insert a 0.3 mL ampule crushed onto a gauze pad in front of their mouth or endotracheal tube so they may breathe in for 15 to 30 seconds.
• The dose may be repeated until sodium nitrite can be administered.
• Amyl nitrite is a temporary intervention that is used in prehospital settings, or if intravenous access is difficult, and until intravenous hydroxocobalamin or sodium nitrite and sodium thiosulfate infusions can be administered.

Pregnancy Risk Factor C/ X

• Although no studies have been done, the manufacturer suggests that pregnant women avoid it as it can significantly lower systemic blood pressure.
• Fetal haemoglobin can also be converted to methemoglobin.

Amyl Nitrite use during breastfeeding:

• You should be cautious while breastfeeding, as the excretion of this drug into breast milk has not been determined.

Amyl Nitrite Dose in Renal Disease:

• No recommendations available

Amyl Nitrite Dose in Liver Disease:

• No recommendations available

Side Effects of Amyl Nitrite Frequency not defined.

• Central Nervous System:
  • Increased Intracranial Pressure
  • Restlessness
  • Dizziness
  • Headache
• Cardiovascular:
  • Tachycardia
  • Vasodilatation
  • Hypotension
  • Orthostatic Hypotension
  • Cerebral Ischemia
  • Facial Flushing
  • Shock
  • Syncope
• Gastrointestinal:
  • Nausea
  • Faecal Incontinence
  • Vomiting
• Dermatologic:
  • Pallor
  • Skin Irritation
  • Dermatitis
  • Diaphoresis
• Genitourinary:
  • Urinary Incontinence
• Neuromuscular & Skeletal:
  • Weakness
• Ophthalmic:
  • Eye Irritation
  • Increased Intraocular Pressure

• Hematologic & Oncologic:
  • Hemolytic Anemia
  • Methemoglobinemia

Contraindications to Amyl Nitrite Include:

• Recent head trauma or cerebral haemorrhage.
• Pregnancy
• Glaucoma
• Concurrent carbon monoxide poisoning if used for cyanide poisoning.

Warnings and Precautions

• Hypotension
  • Hypotension can be caused by amyl nitrite, which can sometimes lead to serious complications. 
  • Before therapy can be initiated, the patient must be euvolemic.
  • Before using it, ensure that oxygenation and perfusion are adequate.
  • Patients with an undetermined diagnosis and patients with reduced cardiovascular reserve (like those who smoke, suffer from anemia, blood loss, or have cardiac disease) should be advised to avoid the drug.
  • These patients should be prescribed hydroxocobalamin.

• Methemoglobinemia:
  • This causes methemoglobin to form, which has a lower oxygen-carrying capability. Monitoring the patient is important to ensure adequate oxygenation.
  • Patients with an undetermined diagnosis, patients with anemia, bleeding disorders, or patients who have suffered from cardiac disease, such as smokers, heart attack victims, congenital methemoglobin deficiency, or patients with reduced cardiovascular reserve should be advised to avoid the drug. These patients should be given hydroxocobalamin.
  • Patients taking medications that cause methemoglobinemia such as nitroglycerin or phenazopyridine need to be warned.
• Aortic stenosis
  • Patients with aortic Stenosis should use it with caution due to the risk of impaired coronary perfusion that could lead to ischemia.
• Cardiovascular disease
  • It can cause hypotension, syncope and postural dizziness.
  • Patients with hypotension and patients with coronary artery disease are at particular risk.
• Increased intracranial pressure
  • Patients with recent head trauma or cerebral hemorhage should not use it.

Amyl nitrite: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring Parameters:

• Co-oximetry
• Serum lactate levels
• Blood pressure and heart rate during treatment
• Haemoglobin and Hematocrit
• The arterial and venous partial pressure of oxygen gradient
• Serum methemoglobin and Oxyhemoglobin

How to administer Amyl Nitrite:

• Administer via nasal inhalation. Ask the patient to lie down.
• Place a piece of crushed gauze in front of the patient's mouth or endotracheal tube in patients who have been intubated.
• To inhale it for 15 to 30 seconds, instruct the patient.
• Until sodium nitrite can be delivered, repeat every minute. A single ampoule lasts around three minutes.

Mechanism of action of Amyl Nitrite:

• It eases the smooth muscle of the blood arteries, brings down arterial blood pressure, lessens left ventricular effort, and lowers myocardial oxygen consumption.
• It encourages the production of met haemoglobin, which challenges the cyanide ions for dominance. Cyano-methemoglobin is produced when methemoglobin and cyanide are combined.
• This frees the cytochrome oxygenase and allows aerobic metabolism to continue.

It has been the beginning of action Within half an hour. The anti-anginal effects can last between 3 and 15 minutes. The effect lasts about 30 seconds when used to diagnose hypertrophic cardiomyopathy (pharmacologic stimulation of LVOT gradient).

It is easily available and absorbed by inhalation through your respiratory tract.

Metabolized Inorganic nitrates are less potent and can be found in the liver.

Half-life elimination The time taken to prepare Amyl Nitride is less than an hour, while that for met haemoglobin takes one hour. 33% of the drug can be found in this form.

Excreted Via urine

International Brands of Amyl Nitrite:

• Amyl Nitrite

Amyl Nitrite Brands in Pakistan:

No brands are available in Pakistan.