Inhalants (glues, solvents, thinner, aerosols, and gases)
Inhalants are chemical substances whose vapours are breathed in to produce a brief high and disinhibition. Repeated use may cause brain, heart, liver, and kidney damage. Relevant pharmacological interactions with modern antiretrovirals are not expected.
What are they?
Inhalants are chemical substances whose vapours are breathed in to produce psychoactive effects. They include:
- Glues and adhesives (toluene, acetone)
- Organic solvents
- Thinner and paint diluents
- Aerosols (spray paint, deodorants, cooking sprays)
- Gases (butane, nitrous oxide)
- Household or industrial products
Their effects are brief, but the risks are high, especially with repeated use.
How are they used?
- Inhalation of vapours: directly from the container, from a bag, or from a soaked cloth
- Never swallow or inject
- Do not apply to eyes, skin, or mucous membranes
- Always use in ventilated spaces (never in closed spaces)
How do they work?
Inhalants rapidly depress the central nervous system, producing:
- Brief euphoria and a feeling of well-being
- Disinhibition and changes in perception
- Dizziness or drowsiness
- Changes in motor coordination
- Risk of loss of consciousness (even with a single exposure)
The effect is very short (minutes), which may lead to repeated inhalation and higher toxicity.
Repeated use may cause: permanent brain damage, heart damage (including fatal arrhythmias), liver damage, and kidney damage.
Interactions with antiretrovirals
Inhalants do not produce clinically relevant pharmacological interactions with most modern antiretrovirals.
No relevant known interactions with:
| Medicine | Interaction |
|---|---|
| Dolutegravir | No relevant interaction |
| Bictegravir | No relevant interaction |
| Cabotegravir | No relevant interaction |
| Raltegravir | No relevant interaction |
| Tenofovir | No relevant interaction |
| Emtricitabine | No relevant interaction |
| Lamivudine | No relevant interaction |
| Efavirenz | No relevant pharmacological interaction |
| Nevirapine | No relevant pharmacological interaction |
| Lenacapavir | No relevant interaction |
What may still be affected
They may INCREASE:
- Dizziness and drowsiness (additive effect with other medicines that act on the CNS)
- Risk of respiratory depression when combined with other substances (alcohol, benzodiazepines, opioids)
- Liver, kidney, and nervous system damage that may affect medicine tolerance and metabolism
They may DECREASE:
- Reaction capacity, attention, and coordination
- Chronic use may interfere with ART adherence because of cognitive problems or disorganisation
Harm reduction
- Use only in ventilated spaces or outdoors
- NEVER combine with alcohol, benzodiazepines, opioids, or other CNS depressants
- Avoid repeated or daily use (cumulative risk of brain, heart, and liver damage)
- Do not use near fire or heat sources (ignition risk)
- Avoid concentrated industrial products (higher toxicity)
- Do not drive or do tasks that require coordination or attention
- Use with a trusted person who is not using
Warning signs
- Severe and persistent headache
- Nausea or vomiting
- Confusion or disorientation
- Loss of consciousness (even briefly)
- Chest pain or trouble breathing
When should you seek medical care?
- Loss of consciousness or seizures
- Trouble breathing
- Chest pain or irregular heartbeat
- Prolonged exposure in closed spaces
- Symptoms that do not improve after moving to fresh air
If there is loss of consciousness, call emergency services immediately and move the person to fresh air.
What does the evidence say?
Inhalants do not have an established pharmacological interaction profile with modern antiretrovirals. However, their direct toxic effects on the liver, kidneys, and central nervous system may indirectly affect the metabolism of some medicines and increase vulnerability to adverse effects. Sudden sniffing death syndrome (SSDS) may happen even on first exposure and is mainly due to cardiac arrhythmias. Chronic use is linked to progressive and irreversible neurological damage.