Ammonia Spirit, Aromatic (Inhalation-Systemic)


VA CLASSIFICATION
Primary: RE900

Another commonly used name is
smelling salts . {09}
Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).

Not commercially available in Canada.



Category:


Respiratory stimulant{02}{07}{12}

Indications

Accepted

Syncope (prophylaxis and treatment)—Aromatic ammonia spirit is indicated to treat or prevent syncope (fainting). {01} {04} {06} {07} {08} {10} {11} {12}


Pharmacology/Pharmacokinetics

Mechanism of action/Effect:

Respiratory stimulant—Aromatic ammonia spirit is a reflex respiratory stimulant that acts by causing peripheral irritation of the sensory receptors in the nasal mucous membranes, esophageal mucosa, and fundus of the stomach. {01}


Other actions/effects:

Aromatic ammonia spirit has antacid and carminative properties. {01}


Precautions to Consider

Pregnancy/Reproduction

Pregnancy—
Problems in humans have not been documented.

Breast-feeding

It is not known whether aromatic ammonia spirit is distributed into breast milk. However, problems in humans have not been documented.

Pediatrics

Appropriate studies performed to date have not demonstrated pediatrics-specific problems that would limit the usefulness of aromatic ammonia spirit in children. {15} {16} {17} {18} {19} However, this medication should be used in children only when directed by a physician. {10}


Geriatrics


Appropriate studies on the relationship of age to the effects of aromatic ammonia spirit have not been performed in the geriatric population. However, no geriatrics-specific problems have been documented to date.

Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).


Risk-benefit should be considered when the following medical problems exist
Eye problems or
Respiratory disease or impairment    (these conditions may be aggravated by the use of aromatic ammonia spirit {05})


» Flushed face{11}{12}{16}    (when associated with syncope, flushed face may indicate the presence of cardiovascular disease or cerebrovascular disturbance {24})




Side/Adverse Effects

Note: Inhaling high concentrations of ammonia can cause severe lung damage, but the small amount of ammonia inhaled from aromatic ammonia spirit inhalants has not been reported to cause toxicity. {06}
If aromatic ammonia spirit comes into contact with the eyes or skin, burns and irritation may occur. Burns in the eyes may lead to blindness. {05}

The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:

Those indicating need for medical attention
Incidence less frequent
    
Cough {05}{08}{16}
    
diarrhea {05}{16}
    
difficulty in breathing {05}{16}
    
headache {05}
    
vomiting {05}{08}{16}





Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Ammonia Spirit, Aromatic (Inhalation).

In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Before using this medication
»   Conditions affecting use, especially:
Sensitivity to aromatic ammonia spirit





Use in children—Use not recommended unless directed by physician {10}


Proper use of this medication

» Proper dosing

» Proper storage

Precautions while using this medication
» Checking with physician if you are an older adult or have history of heart problems; fainting may signal a serious medical problem {13}

» Keeping medication away from eyes and skin

Following eye contact, flushing eyes with a gentle stream of water for 20 minutes and calling poison control center, physician, or emergency room immediately

Following external exposure, removing contaminated clothing, flushing skin with water, not rubbing or applying ointment to skin; calling physician if skin irritation persists

Following ingestion of a large amount of solution, drinking a glass (8 ounces) of water and calling poison control center, physician, or emergency room immediately


Side/adverse effects
Signs of potential side effects, especially cough, diarrhea, difficulty in breathing, headache, and vomiting


General Dosing Information
Aromatic ammonia spirit should be kept away from the eyes and should not be allowed to come into contact with the skin. {05} {12}

Esophagoscopy is not routinely indicated following acute ingestion of an aromatic ammonia spirit inhalant because the contact time with esophageal tissue is limited and the volume contained in the capsule is extremely small (0.33 mL). {08} {09}

For treatment of adverse effects {05}
Recommended treatment consists of the following:

   • Following eye contact—Flushing the eye with a gentle stream {21} of water for 20 minutes; {22} holding the eyelid away from the eyeball to facilitate thorough rinsing.
   • Following external exposure—Removing contaminated clothing and {21} flushing the affected area with large amounts of water. Not rubbing or applying ointment to the affected area.
   • Following ingestion of a large amount of solution—Having patient drink a glass (8 ounces) of water; {20} {23} evaluating for burns in the mouth and throat if a significant amount of solution has been ingested. {23}
For more information on the management of overdose or unintentional exposure, contact a Poison Control Center {21}(see Poison Control Center Listing ).


Inhalation Dosage Forms

AROMATIC AMMONIA SPIRIT INHALANT

Usual adult and adolescent dose
Respiratory stimulant
Inhalation, inhalant should be held away from the face and crushed between the fingers. The inhalant should then be held approximately four inches from the nostrils, and the vapor slowly inhaled {11} {12} until the patient awakens or no longer feels faint.


Usual pediatric dose
Use is not recommended unless directed by a physician. {10}

Usual geriatric dose
See Usual adult and adolescent dose.

Strength(s) usually available
U.S.—


0.33 mL (OTC)[Generic](ammonia 15%)(alcohol 35%)
{11}{12}
Canada—
Not commercially available. {14}

Packaging and storage:
Store at a temperature not exceeding 30 °C (86 °F) in a light-resistant container. {07}


AROMATIC AMMONIA SPIRIT USP

Usual adult and adolescent dose
Respiratory stimulant
Inhalation of vapor {01} {07} {10} until the patient awakens or no longer feels faint.


Usual pediatric dose
Use is not recommended unless directed by a physician. {10}

Usual geriatric dose
See Usual adult and adolescent dose.

Strength(s) usually available
U.S.—


100 mL (OTC)[Generic](total ammonia 1.9 grams)(ammonium carbonate 4 grams)(lemon oil)(lavender oil)(nutmeg oil)(alcohol 65%)
{01}{03}{04}{06}{07}{10}
Canada—
Not commercially available. {14}

Packaging and storage:
Store at a temperature not exceeding 30 °C (86 °F) in a tight, light-resistant container. {01} {03} {07} {10}

Incompatibilities:
Aromatic ammonia spirit is incompatible with acids, {05} aqueous preparations containing alkaloids or of low alcoholic content, {07} halogens, hypochlorites, and sodium hydroxide. {05}

Auxiliary labeling:
   • Keep container tightly closed. {10}



Developed: 06/23/1995



References
  1. McEvoy GK, editor. AHFS Drug information 94. Bethesda, MD: American Society of Hospital Pharmacists, 1994: 1471.
  1. Fleeger CA, editor. USP dictionary of USAN and international drug names 1995. Rockville, MD: The United States Pharmacopeial Convention, Inc., 1994: 46.
  1. The United States pharmacopeia. The national formulary. USP 23rd revision (January 1, 1995). NF 18th ed (January 1, 1995). Rockville, MD: The United States Pharmacopeial Convention, Inc., 1994: 94.
  1. Gilman AG, Rall TW, Nies AS, Taylor P, editors. Goodman and Gilman's the pharmacological basis of therapeutics. 8th ed. New York: Pergamon Press, 1990: 697.
  1. Ammonia inhalants material safety data sheet (UDL—US), Rev 6/89, Rec 2/8/95.
  1. Campbell SC. Severe ventilatory depression reversed with aromatic ammonia inhalation [letter]. N Engl J Med 1988; 319: 1550.
  1. Gennaro AR, editor. Remington's pharmaceutical sciences. 18th ed. Easton, PA: Mack Publishing Company, 1990: 1533-4.
  1. Lopez GP, Dean BS, Krenzelok EP. Oral exposure to ammonia inhalants: a report of 8 cases [abstract]. Vet Hum Toxicol 1988; 30: 350.
  1. Wason S, Stephan M, Breide C. Ingestion of aromatic ammonia “smelling salts” capsules [letter]. Am J Dis Child 1990; 144: 139-40.
  1. Aromatic ammonia spirit package labeling (RiteAid—US), Rec 3/2/95.
  1. Ammonia inhalants package labeling (PharmaTek—US), Rec 2/12/95.
  1. Ammonia inhalants package labeling (Zee Medical—US), Rec 3/3/95.
  1. Berkow R, editor. The Merck manual of diagnosis and therapy. 16th ed. Rahway, NJ: Merck Research Laboratories, 1992: 431-4.
  1. Panel comment, 2/95.
  1. Dixon JM, Helsel WJ, Rojahn J, et al. Aversive conditioning of visual screening with aromatic ammonia for treating aggressive and disruptive behavior in a developmentally disabled child. Behav Modif 1989; 13: 91-107.
  1. Rapoff MA, Altman K, Christophersen ER. Suppression of self-injurious behaviour: determining the least restrictive alternative. J Ment Defic Res 1980; 24: 37-46.
  1. Singh NN, Dawson MJ, Gregory PR. Self-injury in the profoundly retarded: clinically significant versus therapeutic control. J Ment Defic Res 1980; 24: 87-97.
  1. Altman K, Haavik S, Cook JW. Punishment of self-injurious behavior in natural settings using contingent aromatic ammonia. Behav Res Ther 1978; 16: 85-96.
  1. Baumeister AA, Baumeister AA. Suppression of repetitive self-injurious behavior by contingent inhalation of aromatic ammonia. J Autism Child Schizophr 1978; 8: 71-7.
  1. Panel comment, 4/95.
  1. Panel comment, 4/95.
  1. Panel comment, 4/95.
  1. Panel comment, 4/95.
  1. Manufacturer comment, 4/95.
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