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FDA Cracking Down on Decongestant Misuse

by Rachel Gaddis

February 22, 2022
Decongestant Misuse

An FDA warning concerning OTC decongestant misuse last spring pointed out the harm caused by the misuse of nasal decongestants like propylhexedrine. The U.S. Food and Drug Administration is requesting inhaler manufacturers make physical design changes to help counter this misuse. Although cough decongestants are proven effective, people are increasingly extracting propylhexedrine from these inhalers for recreational use.

Before I outline the scope of this problem and the reason for FDA intervention, a few words about propylhexedrine. It might surprise you to know that this substance is not dissimilar to crystal meth.

What Is Propylhexedrine?

According to the FDA, propylhexedrine is only presently marketed under the brand name Benzedrex. When used as intended and for short spells, Benzedrex is both safe and highly effective. It relieves the congestion caused by hay fever, colds, or allergies.

If misused, though, the structural similarity of propylhexedrine to methamphetamine triggers euphoric effects and is potentially dangerous. There is only a single chemical difference between these two substances.

The National Capital Poison Center (NCPC) shines a light on reports of toxicity linked to propylhexedrine being extracted from inhalers. Users either swallow or inject the substance. Although the aim is to improve concentration and productivity, the result can be deadly.

According to the NCPC, both children and adults have experienced lung injuries and heart attacks after swallowing the contents of a single propylhexedrine inhaler. Many other adverse outcomes are also possible.

With misuse of this OTC decongestant on the rise, the FDA issued a news release in March 2021 requesting that product design changes be implemented and made two suggestions to help manufacturers achieve this:

  1. Create a physical barrier to make it harder to extract the propylhexedrine from inside nasal decongestants.
  2. Reduce the propylhexedrine content in inhalers.

The agency will continue monitoring this issue and take further action if needed. But what is the true nature of the problem with Benzedrex misuse you might wonder?

How Does Benzedrex Work?

Benzedrex is a branded intranasal inhaler intended to temporarily soothe nasal congestion resulting from colds or allergies.

Until 1949, the active ingredient in Benzedrex inhalers was amphetamine sulfate. This led to the routine abuse of these inhalers, and the manufacturer introduced propylhexedrine as a substitute for amphetamine.

Propylhexedrine acts as a stimulant, so taking the drug triggers the release of dopamine, serotonin, and norepinephrine from cells in your body. The effects of this drug mirror the innate response baked into people or animals when acutely stressed. Propylhexedrine causes your blood vessels to narrow – vasoconstriction – a property that renders it an effective decongestant.

When you consider the association between propylhexedrine and amphetamine, it becomes clear why so many people are abusing Benzedrex.

Recreational Benzedrex Abuse

Some research indicates that people misusing Benzedrex do not normally use the inhaler as directed. Instead, they swallow the medication or inject it intravenously. Misusing this OTC decongestant can cause serious health problems and even death – more on that directly. Why, then, are more people misusing Benzedrex given the likely negative consequences?

People use propylhexedrine recreationally in patterns similar to the abuse of amphetamine, meth, or dextroamphetamine. Other times, people misuse this drug for perceived improvements to focus and productivity. (This doesn’t typically work out so well.)

The high experienced when taking propylhexedrine is similar to that induced by other amphetamines, but even more euphoric; the duration of the high is much shorter, though. For recreational users, this is an obvious drawback. Recreational doses of Benzedrex also can cause side effects even worse than those induced by meth. This is why long-term misuse is inadvisable and potentially hazardous.

The Effects of OTC Decongestant Abuse

When taken as instructed, Benzedrex is typically not dangerous. Some people still might experience a cluster of benign side effects, including:

  • Burning nasal passages
  • Dryness
  • Rebound congestion
  • Restlessness
  • Sweating
  • Tremors

While unpleasant, the benefits of the medication outweigh the drawbacks for most users.

In the event of Benzedrex misuse, though, you can expect a laundry list of significant negative outcomes, including:

  • Fever and chills
  • Heart issues (blood pressure changes, cardiopulmonary arrest, chest pain, excess fluid around heart, heart attacks, heart palpitations, irregular heartbeat)
  • Psychosis
  • Sepsis
  • Death

Injecting propylhexedrine, specifically, brings about many risks, including:

  • Abscesses
  • Altered sensations
  • Bruising
  • Cellulitis
  • Tissue death
  • Ulcers

When injected, propylhexedrine can lead to even more serious and toxic organ problems than amphetamine. This is due to the way the drug simultaneously raises blood pressure and constricts blood vessels.

Long-term health problems can easily develop with daily use. The risk of heart damage, especially, can increase when used daily.

Overall, long-term negative side effects are known to be similar to those caused by MDMA abuse.

What Comes Next

OTC decongestant misuse can trigger the same problems as misusing illegal drugs or alcohol. Like any addiction, though, it is eminently treatable.

By following a structured residential or outpatient program, you will benefit from psychotherapy to help you explore why you misuse nasal decongestants. You will also learn healthier coping mechanisms for the stressors in life that lead you to misuse substances.

Landmark Recovery’s goal is to help one million people — just like you — reclaim their lives from substance use disorders. No one will be more dedicated to helping you achieve this. Call us today at 888-448-0302 and speak with a recovery specialist 24/7 about how Landmark Recovery can come alongside you.

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