Several unapproved inhalants being marketed to "promote alertness and boost energy" contain mostly ammonia, a toxic gas that can sometimes cause severe symptoms when inhaled, the U.S. Food and Drug Administration (FDA) warned Monday (May 1).
"Inhaling ammonia can quickly lead to eye, nose, and throat irritation; coughing; and airway constriction," the FDA warning reads. "FDA has received reports of adverse events such as shortness of breath, seizures, migraines, vomiting, diarrhea, and fainting from consumers" who used the unapproved stimulants, which are called "Nose Slap" and "Soul Slap."
The FDA issued its consumer safety warning after sending a letter to the products' maker, Nose Slap LLC, on April 24. The warning letter names the two stimulants being sold on the company's website, neither of which is FDA approved. According to the letter, Nose Slap and Soul Slap are advertised as energy-boosting alternatives to sugar and caffeine, and the company's website notes that both inhalants contain ammonia.
Specifically, the products are described as "extremely powerful" smelling salts. In general, smelling salts work by using ammonia to irritate the mucous membranes of the upper respiratory tract and trigger an inhalation reflex. This reflex, in turn, alters a person's breathing and increases oxygen flow and gas exchange in their lungs, which may potentially increase alertness.
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Once used to prevent or treat fainting, smelling salts are no longer regularly used by doctors, but they are sometimes used by athletes in an effort to improve performance, although there's little evidence to support this use. Still, smelling salts are considered relatively safe — but inhaling ammonia frequently or in high doses is harmful. And again, because Nose Slap and Soul Slap are unapproved, the FDA can't vouch for the products' quality or safety.
Depending on the dose inhaled, ammonia can burn the tissues of the nose, throat and windpipe; cause swelling and an accumulation of fluid in the lungs; and cause "airway destruction resulting in respiratory distress or failure," in addition to the previously listed symptoms, according to the Centers for Disease Control and Prevention (CDC).
Those who survive inhaling very high concentrations of ammonia can experience long-term lung damage, and if the chemical enters the eyes, it can damage the cornea and sometimes lead to blindness, the CDC notes.
In its warning statement, the FDA encouraged health care professionals and consumers to report adverse events or quality problems with Nose Slap or Soul Slap to the agency's MedWatch Adverse Event Reporting Program.
"These products have not been demonstrated to be safe or effective for their intended uses," the FDA stated. "Failure of the company to promptly correct violations may result in legal action without further notice, including, without limitation, product seizure and injunction."
