The FDA is warning that the abuse and misuse of the over-the-counter (OTC) nasal decongestant propylhexedrine can lead to serious harm such as heart and mental health problems.
Reports of individuals abusing and misusing propylhexedrine have increased in recent years.
Over past two decades, US poison control centers documented 460 cases of propylhexedrine abuse (415 cases) or misuse (45 cases). On a yearly basis, cases increased from 11 in 2011 to 74 in 2019; abuse cases constituted most of this increase.
In the United States, propylhexedrine is available as an inhaler for relief of nasal congestion due to colds, allergic rhinitis, and sinusitis under the trade name Benzedrex.
Inside a Benzedrex inhaler is a cotton ball soaked with propylhexedrine. Various Internet sites give detailed instructions on how to extract the drug. Most individuals who abuse Benzedrex receive the drug in one of these ways: They swallow the cotton ball whole, or they soak the cotton in lemon juice for a few hours and then either drink the liquid or take it intravenously.
The extract can be insufflated, injected, ingested or smoked.
Each plastic tube contains a total of 250 mg/container. The product delivers 0.4-0.5 mg per inhalation. The bottle contains 0.42 ml. The product also contains unspecified amounts of lavender oil and menthol.
When used in doses of 100 to 300 mg, the drug can produce psychoactive effects that are similar to those of amphetamines.
The FDA has received reports of patients experiencing serious adverse events:
- Rapid Heart Rate or Abnormal Heart Rhythm
- Agitation
- High Blood Pressure
- Chest Pain
- Tremors
- Hallucinations
- Delusions
- Confusion
- Nausea and Vomiting
If you have questions about a potential exposure to propylhexedrine, the poison center is available 24/7 to assist you. Medical toxicologist consult is always available at 1-800-222-1222.
- U.S. Food and Drug Administration. Benzedrex (Propylhexedrine): Drug Safety Communication., March 25, 2021
- U.S. Food and Drug Administration. “FDA warns that abuse and misuse of the nasal decongestant propylhexedrine causes serious harm.”, March 25, 2021
* Reddit. www.reddit.com/propylhexedrine.
- Webpoisoncontrol. Propylhexedrine Monograph, 2021.
- Medscape Medical News. “Active Ingredient in OTC Inhaler a ‘New’ Drug of Abuse., December 19, 2019.
* Micromedex, Poisondex Monograpth, 2021.
Question prepared by Jeff Moore RN, CSPI (Certified Specialist in Poison Information)
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Donna Seger, MD
Executive Director
Tennessee Poison Center www.tnpoisoncenter.org
Poison Help Hotline: 1-800-222-1222