Propylhexedrine, an α-adrenergic sympathomimetic amine that is structurally related to amphetamine, is a vasoconstrictor.2, 3, 4
Propylhexedrine is a topical nasal decongestant used as self-medication for the temporary relief of nasal congestion due to a cold, hay fever, or other upper respiratory allergies (allergic rhinitis).1, 101 When administered intranasally, the drug reduces swelling and inflammation of the nasal mucosa.2, 5 Propylhexedrine is intended only for short-term use; prolonged use may cause worsening or recurrence of nasal congestion.1
Propylhexedrine is administered by nasal inhalation via an inhaler.1 The inhaler should not be used by more than one patient to avoid contamination.1
The propylhexedrine inhaler should be tightly closed.1 The inhaler is effective for a minimum of 3 months after first use.1
Use in children 6-12 years of age should be under adult supervision.1
The Benzedrex® propylhexedrine inhaler delivers 0.4-0.5 mg of the drug in each 800 mL of air.101
In adults and children 6 years of age and older, the recommended dosage of propylhexedrine is 2 inhalations (approximately 0.4-0.5 mg of the drug) in each nostril not more than every 2 hours.1, 101 In children less than 6 years of age, dosage must be determined by a physician.1 Do not use propylhexedrine for more than 3 days; if symptoms are not improved after 3 days, consult a clinician.1
Propylhexedrine can cause transient burning, stinging, sneezing, or increased nasal discharge.1 Frequent or prolonged use may cause nasal congestion to worsen or recur.1
Use propylhexedrine only as directed.1 Do not exceed the recommended dosage and duration of use.1
Use of the propylhexedrine product by more than one individual may spread infection.1
Abuse and misuse of propylhexedrine have been reported, particularly by routes other than nasal inhalation (e.g., oral ingestion, injection), resulting in serious cardiac and psychiatric events including death.3, 4, 5 Propylhexedrine has psychostimulating properties when administered in doses of 100 to 300 mg orally.2 Abuse and misuse of propylhexedrine have increased in recent years with a sharp rise in 2015.5 To further evaluate these findings, the FDA reviewed data from poison centers, the FDA Adverse Event Reporting System (FAERS) database, other published case reports, and an observational study.5 Many of these cases involved males who were administering the drug by oral ingestion or injection, sometimes in combination with other substances.5 Reported adverse effects were generally related to the sympathomimetic effects of the drug and included tachycardia, agitation, hypertension, mydriasis, nausea, chest pain, tremor, hallucinations/delusions, diaphoresis, confusion, and vomiting.5 In older literature reports, ischemic limb injury, cranial nerve dysfunction, psychosis, cardiomyopathy, adrenergic overstimulation, and anxiety or agitation were also reported.5 In some cases, life-threatening adverse effects resulted in hospitalization, admission to the intensive care unit (ICU), or death.5
Propylhexedrine is safe and effective when used as directed and should only be used in accordance with the Drug Facts label.5 In the event of a suspected overdose, healthcare providers should attempt to determine whether a patient used propylhexedrine alone or with other substances.5 There is no specific reversal agent in cases of acute propylhexedrine intoxication; management is symptomatic and supportive.5
Patients who are pregnant should consult their clinician prior to use.1
Patients who are breastfeeding should consult their clinician prior to use.1
Safety and efficacy of propylhexedrine have not been established in children <6 years of age.1
Common adverse effects of propylhexedrine include burning, stinging, sneezing, and increase in nasal discharge.1
Propylhexedrine is a potent α-adrenergic sympathomimetic amine that is structurally related to amphetamine.2, 3, 4
Propylhexedrine acts as a local vasoconstrictor by antagonizing α- and β-adrenergic receptors in the mucosa of the respiratory tract; when administered intranasally, the drug decreases swelling and inflammation of the mucous membrane lining the nasal passages.2, 3 Although structurally similar to amphetamine, propylhexedrine exhibits 1/12th of the CNS stimulating effects of amphetamine.4
Additional Information
The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer's labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Nasal | Inhalant | 175 mg | Benzedrex® Inhaler | Ascher |
AHFS® Drug Information. © Copyright, 1959-2025, Selected Revisions May 10, 2025. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, MD 20814.
Only references cited for selected revisions after 1984 are available electronically.
1. B.F. Ascher Pharmaceuticals. Benzedrex® (propylhexedrine) inhalant drug facts. Shawnee Mission, KS. 2024 Dec.
2. Wesson DR. Propylhexedrine. Drug Alcohol Depend. 1986 Jun;17(2-3):273-8. doi: 10.1016/0376-8716(86)90013-x. PMID: 2874970.
3. Teja N, Dodge CP, Stanciu CN. Abuse, Toxicology and the Resurgence of Propylhexedrine: A Case Report and Review of Literature. Cureus. 2020 Oct 9;12(10):e10868. doi: 10.7759/cureus.10868. PMID: 33178521; PMCID: PMC7652022.
4. Holler JM, Vorce SP, McDonough-Bender PC, Magluilo J Jr, Solomon CJ, Levine B. A drug toxicity death involving propylhexedrine and mitragynine. J Anal Toxicol. 2011 Jan;35(1):54-9. doi: 10.1093/anatox/35.1.54. PMID: 21219704.
5. US Food and Drug Administration. FDA drug safety communication: FDA warns that abuse and misuse of the nasal decongestant propylhexedrine causes serious harm (March 25, 2021). [Web]
101. US Food and Drug Administration. Over-the-Counter Monograph M012: Cold, Cough, Allergy, Bronchodilator, and Antiasthmatic Drug Products for Over-the-Counter Human Use; final administrative order (OTC000026). Posted October 14, 2022. [Web]