Alkyl nitrites (poppers)

Headache, dizziness, a fast heartbeat, nausea and fainting can occur. Methaemoglobinaemia reduces the blood's ability to carry oxygen and can cause breathlessness, blue or grey skin, confusion, collapse or death. Serious toxicity needs emergency assessment, especially following ingestion.

UK case series describe injury to the central retina, sometimes with blurred or distorted central vision after a single episode or repeated use. Recovery can occur after exposure stops, but it is not guaranteed. New visual symptoms warrant prompt assessment. Case series identify a hazard, not the probability that any individual will develop it.

A characteristic physical dependence or withdrawal syndrome has not been established. Some people report relying on poppers in sexual situations; support should address their actual concerns and circumstances rather than assume either addiction or an absence of difficulty.

Do not combine poppers with PDE5 inhibitors such as sildenafil or tadalafil: the combination can produce a dangerous fall in blood pressure. Ask about erectile-dysfunction products obtained online as well as prescribed medicines. Other substance use can complicate assessment; evidence does not support assigning a precise additional risk to every possible combination.