What Are Poppers? Dangers and the Medicines You Must Never Mix

Many people ask me about poppers quite casually, thinking "it's just sniffing, it can't do much". But from a medical point of view, these are chemicals that change your blood pressure very quickly, and there have been fatal cases when they are used the wrong way. This article is not written to judge anyone, but so you know where the real danger lines are.

What are poppers and how do they work?

"Poppers" is the street name for chemicals in the alkyl nitrite group, such as amyl nitrite, isobutyl nitrite and isopropyl nitrite. They come in small bottles as a volatile liquid. Some brands are labelled as cleaning fluid or room aroma. These products do not go through the quality control that medicines do, so you cannot be sure what is in the bottle or how strong it is.

When inhaled, they make blood vessels widen immediately. Blood pressure falls, the heart beats faster to compensate, and smooth muscle relaxes, including the anal sphincter. That is why users feel a hot flush, light-headedness, a floating feeling and brief relaxation. The effect starts within seconds and wears off in about 2–5 minutes.

Short-term dangers

• Light-headedness and fainting from a sudden drop in blood pressure, especially when standing up or with the head raised.
• Headache, palpitations and fast heart rate. People with heart or blood vessel disease are at greater risk.
• Nausea and vomiting, especially in a stuffy room.
• Chemical burns. If the liquid spills onto the nose, lips or skin, it can cause a red rash or crusted sores.
• Accidental swallowing or getting it in the eyes is very dangerous. Swallowing it can cause a severe condition in which the blood cannot carry oxygen, which can be fatal.

Dangers many people don't know about

Never use with erection medicines

This is the most important point. PDE5 inhibitors such as sildenafil and tadalafil also widen blood vessels. Used together with poppers, or with nitrate medicines for heart disease, blood pressure can plummet, causing fainting, heart attack or shock. The labelling of every medicine in this group lists this as a clear contraindication. Tadalafil stays in the body for about 2 days, which means you are still at risk even if you took it yesterday. Read more in Tadalafil and how long it lasts.

Methaemoglobinaemia

Nitrites change haemoglobin so that it cannot carry oxygen. With heavy use or if swallowed, you may become breathless, with blue-grey lips and fingertips, confusion and loss of consciousness. This is an emergency that must be treated in hospital.

Damage to the retina (poppers maculopathy)

There are reports of poppers users seeing a blurred or yellowish spot in the centre of their vision and having difficulty reading, especially with products containing isopropyl nitrite. In the United Kingdom, case series of dozens of patients have been reported since around 2010. Many improve after stopping, but some never fully recover. If your vision is blurred after use, stop and see an eye doctor (ophthalmologist).

Effects on judgment and sexual health

The relaxing effect can mean you don't feel pain, so small tears happen easily, raising the risk of HIV and other sexually transmitted infections. Poppers can also temporarily weaken erections in some people, so they end up taking erection medicine as well, which is the most dangerous combination of all.

Who must never use them

• Anyone who has taken erection medicine (sildenafil, tadalafil, vardenafil) around the same time.
• Anyone using nitrate medicines for heart disease.
• People with heart disease, low blood pressure, glaucoma or anaemia, or who faint easily.
• People using other substances at the same time in chemsex, because the overlapping effects are hard to assess.

If you choose to use them, how to reduce harm

I don't recommend using them. But if you have decided to, at least do the following:

1. Don't use them on the same day as erection medicine, or within 2 days of taking it.
2. Sit or lie down while using. Don't stand, and don't use while driving or in water.
3. Sniff from a distance, keep the liquid off your skin, never swallow it, never put it in your eyes, and keep it out of reach of children.
4. Don't use near flames, because it is highly flammable.
5. Always use condoms and lubricant, and plan PrEP if you have an HIV risk.
6. If you have erection problems, see a doctor to find the cause instead of trying to fix it by mixing drugs yourself.

How Dr. Kris can help

Many people use poppers because they are worried about pain, tension or erections, and these can be managed much more safely, for example through anal health care, treatment of ED as assessed by a doctor, or talking through your worries. At Dr. Kris Clinic, consultations are confidential and non-judgmental, at the clinic and online, including in English.