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The Use of Ammonia
Inhalants Among Athletes
James R. Velasquez, EdD, ATC, CSCS
Exercise and Sports Studies Department, D’Youville College, Buffalo, New York
SUMMARY
AMMONIA INHALANTS (AI) ARE
COMMONLY USED BY ATHLETES
AS POSSIBLE ERGOGENIC AIDS
DURING TRAINING OR COMPETI-
TION. VIRTUALLY, NO RESEARCH
EXISTS THAT HAS EXAMINED AI
EFFECTIVENESS, SAFETY, OR
PREVALENCE AMONG ATHLETES.
ANECDOTALLY, AI USE IS WIDE-
SPREAD, WITH SOME ADVERSE
REACTIONS HAVING BEEN RE-
PORTED. THE PRESENT ARTICLE
SERVES AS AN INTRODUCTION TO
THE USE OF AIS AND EXAMINES
THE ANECDOTAL USE OF AIS
AMONG THE ATHLETIC POPULA-
TION, AS WELL AS THEIR EFFEC-
TIVENESS, PRACTICES, AND
SAFETY. STRENGTH AND CONDI-
TIONING PROFESSIONALS,
COACHES, AND SPORTS MEDI-
CINE PERSONNEL SHOULD BE
FAMILIAR WITH THEIR USE AND
CONTRAINDICATIONS BECAUSE
ADVERSE REACTIONS HAVE BEEN
REPORTED.
INTRODUCTION
Ammonia inhalant (AI) use is
widespread by athletes as a pos-
sible means of temporarily
enhancing athletic performance during
training or competition (3,5). AI use is
common among various athletes as
a means of increasing focus or ‘‘psych-
ing up,’’ and it has been speculated that
AIs are most commonly used for their
purported benefit of increasing muscu-
lar strength for short periods of time
(3). Presently, there is no empirical
evidence supporting this purported
ergogenic effect. The use of AIs can
most commonly be observed anecdot-
ally among powerlifters, weightlifters,
and track and field athletes (3), as well
as within sports such as boxing, foot-
ball, hockey, and mixed martial arts. It
has also been speculated that interest in
AI use has recently experienced a re-
surgence among athletes (5).
AIs are commonly referred to as
smelling salts, ammonia capsules, or
ammonia salts and historically have
been used for the prevention and
treatment of fainting, dizziness, and
lightheadedness. Research on AI use,
risk, and effectiveness among athletic
populations is nonexistent, even though
anecdotal reports indicate that their use
is widespread (3,5). AI use has largely
been advocated against by many health
care professionals and organizations
because AI use can complicate the
evaluation of injury, especially mild
head injuries and concussions.
Research investigating the use of AI
among athletes is nonexistent. Although
the nonergogenic use of AIs has been
reported as early as the 13th century (5),
there is no present research examining
the prevalence of AI use among athletes.
The paucity of research examining the
effectiveness and/or extent of AI use
necessitates that anecdotal reports and
observation be the primary mechanisms
that establish their popularity and extent
of use among athletes. A certain level
of knowledge should be maintained
among those in the strength and
conditioning community because the
use of AIs often occurs concomitantly
with strength training and competitive
sports and possesses a certain degree of
relative risk. There have been adverse
reactions with AI use reported pre-
viously in the literature (3), and the use
of any substance that has the potential
for misuse by athletes must be
understood by strength and con-
ditioning staffs, coaches, and athletic
trainers.
WHAT ARE AIS?
Ammonium carbonate, the active in-
gredient in AIs, is often combined with
scents or perfumes, giving AIs the more
accurate name of aromatic spirits of
ammonia. Ammonium carbonate is
characterized as a respiratory stimulant
that exerts its physiological effect
when inhaled or sniffed. When inhaled,
it causes a rapid and extreme irritation
of the lungs, nose, and mucus mem-
branes of the nasal cavity. This causes
a concomitant rapid inhalation reflex
that causes involuntary inhalation (5).
This reflex then stimulates the
muscles that control breathing to
work faster, accelerating respiration
and stimulating a higher degree of
consciousness.
Historically, AIs have been indicated
for the use of treating fainting, light-
headedness, and dizziness. Today,
the only approved use of AIs in the
United States is for the treatment of
fainting, and this use extends to the
entire general population. According
to Drug Information Online
(http://www.drugs.com/mmx/smelling-
salts.html. Accessed: March 1, 2010),
AIs are classified as respiratory stimu-
lants that act through peripheral
irritation of the respiratory system
KEY WORDS:
ammonia inhalant; smelling salt;
ammonia salt; ergogenic aid
Copyright ÓNational Strength and Conditioning Association Strength and Conditioning Journal | www.nsca-lift.org 33
(7). The use of AIs is most commonly
observed among athletes immediately
before or during competition. During
training, their use often precedes or
accompanies high-intensity strength
training. Anecdotally, it is common
to observe athletes use AIs before
1-repetition maximum (RM) attempts,
especially movements such as the squat,
deadlift, bench press, or power clean.
Furthermore, AI use can also be ob-
served before or during various sporting
events. For example, it is not uncommon
to observe athletes sniff AIs before the
opening kickoff of a football game, in
between rounds of a boxing match, or in
locker rooms during breaks or intermis-
sions of games.
For many reasons, health care pro-
fessionals and sports medicine organ-
izations advocate against the use of AI.
In Canada, the sale of AIs has been
stopped, and they are no longer avail-
able for purchase over-the-counter (6).
Ammonia is a toxic substance, and AI
inhalation merely provides symptom
relief and does nothing, or potentially
complicates, the underlying injury. For
this reason, the use of AIs has fallen out
of favor among sports medicine pro-
fessionals and physicians. However, AI
accessibility still makes their self-pre-
scription by athletes widespread, often
without the knowledge of the coaches
or sports medicine team.
ARE THEY SAFE?
Although anecdotal reports indicate
that AI use poses certain risks among
the athletic population, AIs are gener-
ally considered safe for their indicated
use in treating fainting. However, there
is no empirical research establishing
their safety or ergogenic benefit when
used by athletes during training or
competition. AIs are approved for use
by the Food and Drug Administration
and are available for purchase over-
the-counter in the United States. The
accessibility of AIs makes their poten-
tial misuse high among athletes. AIs
are often found in most commercial
first aid kits where they are indicated
only for use with fainting. The use
of AIs among athletes, based primarily
on anecdotal reports, has been
commonplace as a means of tempo-
rarily increasing consciousness, focus,
and excitement before competition.
Unfortunately, AIs have also been used
by athletes, sports medicine professio-
nals, and coaches as a way of ‘‘clearing
an athlete’s head’’ after injury. This
practice is dangerous because AIs can
lead to a rapid involuntary contraction
of the head and neck that can exacer-
bate an underlying injury. AI use in this
manner also complicates evaluation of
the underlying head injury.
There have been numerous reports of
toxicity, sickness, and death as a result
of ammonium exposure in large doses.
Inhalation of high doses (in much
greater concentrations than what is
present in over-the-counter AIs) can
cause severe lung damage (2). Com-
plications with use of AIs among
athletes is not common but have been
reported (3). As early as 1920, it was
reported that overuse of AIs caused
a boxer to lose consciousness in
between rounds. It was reported in
The New York Times (October 8, 1920)
that the boxer had inhaled enough
ammonia to ‘‘revive a stricken horse.’’
Although cases such as this are very
rare, other cases of adverse events with
the use of AIs have been reported.
Herrick and Herrick (3) have reported
a case of anaphylaxis in a female
powerlifter as a result of AI use. In this
case, the athlete experienced an acute
case of anaphylaxis during a competi-
tion after inhalation of an aromatic AI.
In preparation for an attempt at
a national powerlifting record, the lifter
inhaled the contents of an AI and
immediately began experiencing pro-
gressively worsening signs and symp-
toms of anaphylaxis (3).
There are certain differences and
considerations that must be under-
stood between the use of AIs before
and during athletic competition. While
the safety of AIs before competition or
during training has not been investi-
gated, their use during athletic com-
petition should be prohibited by
members of the coaching and sports
medicine staff. AI use during compe-
tition may indicate that an athlete has
suffered a head injury, may have lost
consciousness at some point during
their competition, or are experiencing
headache, dizziness, or lightheaded-
ness. Use of AIs in any of these
situations may complicate subsequent
evaluation of injury by making it more
difficult for coaches and/or athletic
trainers to identify if an athlete has
suffered a head injury and putting the
athlete at risk if they return to play (5).
Athletes observed self-prescribing AIs
during competition should minimally
be questioned about their use or ideally
screened for potential head injury or
concussion. Recently, there has been
increased media attention and scrutiny
of concussion injuries in sports. Today,
there is a better understanding of the
impact of repeated concussions on
athletes, especially as it pertains to
chronic brain damage and long-term
psychological and emotional health.
There are numerous cases of ex-
athletes suffering complications from
mismanagement of concussions. Some
of these athletes also report misuse of
AIs in treating their concussions.
National Football League (NFL) Hall
of Famer Jim Brown described to
NFLFanhouse.com (http://nfl.fanhouse.
com/2010/03/01/jim-brown-actually-
was-hurt-once. Accessed: March 1,
2010) returning to play after a concus-
sion and specifically mentions ‘‘smell-
ing salts’’ as a method of treatment. Ex-
NFL player Andre Waters reportedly
endured multiple concussions over his
career but often did not report them.
He stated in The New York Times
(January 18, 2007) that he ‘‘stopped
counting after 15 concussions’’ and that
‘‘I’d sniff some smelling salts, then go
back in there.’’ He committed suicide
in 2007, and physicians have concluded
that he had sustained brain damage as
a result of the numerous concussions
he experienced during his career and
that this lead to depression and
ultimately his premature death.
Aside from the danger of masking the
signs and symptoms of injury, other
risks of AI use are present when used
during training or competition. The
use of AIs may predispose athletes to
VOLUME 33 | NUMBER 2 | APRIL 201 1
34
Use of Ammonia Inhalants Among Athletes
injury because they may cause athletes
to do something that they are in-
capable of doing. In training, it is often
observed that athletes will use AIs
immediately before a high-intensity
lift or during 1RM testing. This
method of getting ‘‘psyched up’’ may
be perceived to be helpful by athletes
but may cause an athlete to attempt
a lift at a level of intensity that they
are not capable of completing, putting
the athlete at increased risk of injury.
AI use has also been reported to
induce allergic reactions and is an
irritant to the respiratory tract. Thus,
it has the potential to exacerbate
underlying asthma and trigger
asthma attacks. Athletes with known
asthma or other respiratory condi-
tions should be prohibited from using
AIs at any time.
There have also been reports of AI
use resulting in death as a result of
asphyxiation. One highly publicized
report was of a 14-year boy whose
death was caused by AI use and
resulted in a $5 million award to the
boy’s family. Martin Lee Anderson
wasadmittedtoacommunityboot
camp designed for young criminal
offenders. During a group running
drill, he fell to the ground and was
administered AIs. It was determined
later that the boy suffered from Sickle
cell trait and that this condition was
exacerbated by the AI use. An
autopsy found that he died as a result
of asphyxia because of repeated AI
administration (1). Sickle cell trait
is a condition that decreases the
amount of oxygen carried in the
blood and has been shown to be
a risk factor for sudden death during
physical activity (4). The National
Collegiate Athletic Association re-
cently introduced, in the NCAA
News (April 13, 2010), a mandatory
screening of student athletes for this
condition beginning in the 2010–
2011 academic year.
The use of AIs among athletes,
although common, should not be
approached without concern. Ammo-
nia is a toxic substance in large doses.
The use of AIs may offer a modest
ergogenic effect, but there is no
empirical research that is supportive
of this. However, adverse events have
occurred and been reported (1,3),
and there are certain situations
where AI use among athletes must be
discouraged, most notably during ath-
letic competition and among athletes
with any preexisting medical
condition.
CONCLUSION
The use of AIs during training and
competition necessitates that the
strength and conditioning profes-
sional be knowledgeable of their
use. Whether AI use provides athletes
with any scientifically proven ergo-
genic benefit cannot be answered
given the lack of research examining
AI use during training or competition.
There is no research showing any
increase in strength or athletic per-
formance after their use (3). Research
examining the safety and efficacy of
AIs during training is needed and
would be beneficial in establishing
their potential safety and/or efficacy.
Anecdotally, the use of AIs does seem
to provide athletes with increased
focus and effort. However, it is
prudent to understand that because
their effectiveness has not been docu-
mented among athletes, and the use
of AIs should be approached with
caution. There is no place for AI use
in the care of an injured athlete, and
their use should be discouraged.
Furthermore, strength and
conditioning personnel, coaches,
andathletictrainersshouldalsobe
keenly aware of potential self-utiliza-
tion by athletes. It must also be
understood that even when AIs
are used for purposes for which they
are indicated, their action is only
treatment for their indicated purpose,
their action merely treats a symptom,
and should not replace appropriate
medical evaluation to identify the
cause of the symptom.
Dr. James
Velasquez is
an assistant pro-
fessor and coordi-
nator within the
Exercise and
Sports Studies
Department at
D’Youville College,
Buffalo, NY.
REFERENCES
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2. Campbell S. Severe ventilatory depression
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aromatic ammonia inhalant ampule: A case
report. Am J Sports Med 11: 28, 1983.
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Ruehle CJ. Sickle-cell trait as a risk factor for
sudden death in physical training. NEnglJ
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