Levmetamfetamine

What it is

Levmetamfetamine is one of the two mirror-image forms of methamphetamine. The paper that first described its human pharmacology states that the d-form is the commonly abused, prescription-only isomer while the l-form is sold over the counter as the active ingredient of a plastic nasal inhaler, and that each inhaler holds about 50 mg of it. A US Drug Facts label for such an inhaler lists the active ingredient as "Levmetamfetamine 50 mg" per inhaler and its purpose as a nasal decongestant. The Drug Enforcement Administration has formally excluded the branded inhaler from the provisions of the Controlled Substances Act.

What the research says

The honest state of the evidence is that almost nothing has been published on whether it relieves a blocked nose. The one controlled human pharmacology study, published in 2008, says plainly that there were no published data on the pharmacology of intranasal l-methamphetamine before it, and that there is surprisingly little published data on over-the-counter nasal decongestants generally. That study measured blood pressure, heart function, drug levels and a set of visual-analogue ratings that did include nasal stuffiness; but its volunteers were screened to have no nasal pathology and had used no decongestant for three months, so they were not congested, and the stuffiness rating did not change. It found the delivered dose tiny and the physiological effects minimal and not dose-dependent. Where there IS a real literature is in drug testing: controlled-dosing studies show that using the inhaler as directed can make an amphetamine urine or saliva screen read positive even though no d-methamphetamine is present.

Evidence grade: Not enough research to say.

How it works

Drug class: Topical (intranasal) sympathomimetic amine decongestant; the levorotatory (l) enantiomer of methamphetamine

Methamphetamine works indirectly rather than by locking onto a receptor itself: the review passage in the 2008 pharmacology paper describes it as an indirectly acting sympathomimetic amine that pushes nerve endings to release noradrenaline and dopamine and blocks their re-uptake, which switches on sympathetic nerve signalling. The same passage notes that sustained exposure to high doses instead depletes those monoamines, and that someone using the inhaler only occasionally, such as a person with a cold, may still have fuller catecholamine stores and so could respond more strongly to a small dose than a chronic user would. (Source 1)

What it is used for

• This is the labelled use, and 21 CFR 341.20 lists levmetamfetamine among the topical nasal decongestant active ingredients permitted over the counter. We searched Europe PMC and found no randomised efficacy trial of levmetamfetamine for nasal congestion; that absence is our own search result and is not asserted by any source cited here. The one controlled human study measured drug levels, cardiovascular variables and visual-analogue ratings including nasal stuffiness, but its volunteers were healthy and not congested, so it could not show whether the inhaler relieves a blocked nose. Evidence: unknown. (Source 2)
• The 2008 study found only small pleasurable effects, rising to 9.7 on a 0 to 100 scale, with increases of a similar magnitude in ratings of a bad drug effect and dizziness whose peak effects the paper calls trivial and non-significant. The authors read this as a low potential for abuse from this product, while noting that abuse of the inhaler has nonetheless been reported in the literature. Evidence: not-supported. (Source 3)

Interactions

• Amphetamine immunoassay urine drug screens (an analytical interference, not a pharmacological interaction) (pharmacokinetic study): This is not a drug acting on another drug. Legitimate use of the inhaler puts l-methamphetamine into urine, which the authors of this controlled-dosing study say may complicate interpretation of urine drug tests positive for amphetamines. A chiral confirmation test is what separates the two mirror-image forms. Oral fluid is a different matrix with different cut-offs; it is covered by a separate controlled study reported under harms in this entry, not by this one. (Source 4)
• Caffeine, nicotine and alcohol (theoretical): No study has measured what happens when this inhaler is combined with caffeine or alcohol. The one human pharmacology study deliberately excluded them: people had to avoid nicotine and caffeine for about 12 hours and alcohol for 48 hours before dosing, and no caffeine was allowed until the exercise echocardiograms were done. So the combination was designed out of the study rather than tested. (Source 5)

Stopping it

• The label's own position is that this is a short-course product: it is not to be used for more than seven days, and it warns that frequent or prolonged use may make congestion come back or worsen. There is no tapering schedule in the literature we found. (Source 6)
• A 2025 review of topical nasal decongestants describes the pattern people fall into when they do not stop: the response gets shorter, they use more, and the congestion gets worse, which the review calls a dependency on the vasoconstrictor. The review's evidence is mainly about imidazoline decongestants, not specifically levmetamfetamine. (Source 7)
• Nothing in the human pharmacology study points to a withdrawal syndrome from the inhaler. Subjective effects were modest, and the authors read the ratings as showing that people who do not use drugs did not find inhaling it pleasurable. (Source 3)

What goes wrong

In a controlled-dosing study using the inhaler at the manufacturer's recommended doses, one of three commercial amphetamine immunoassays produced false-positive urine results, so a positive screen could follow legitimate use. (Source 8)

• Blood level study, Moderate certainty.
• Size: 22 healthy adults, every urine void collected for 32 hours.
• Who: healthy adults given one dose (two inhalations in each nostril) every 2 hours for 10 hours on day 1 and a single dose on day 2.
• How long: 2 days of dosing, 32 hours of collection.
• Result: No d-methamphetamine or d-amphetamine detected by GC-MS in any specimen; EMIT II Plus produced 2.2% false-positive results; sensitivities, specificities and efficiencies were 100, 97.8, 97.8 for EMIT II Plus, 100, 99.6, 99.6 for KIMS II and 100, 100, 100% for DRI.
• Funding: not stated in the abstract (study conducted at the US National Institute on Drug Abuse intramural programme)

The EMIT(®) II Plus assay produced 2.2% false-positive results, requiring an enantiomer-specific confirmation.

An earlier controlled study found that 17 of 132 urine specimens from people using the inhaler were positive on an older EMIT class assay, including specimens from a person using it exactly as the manufacturer recommended. (Source 9)

• Blood level study, Low certainty.
• Size: 6 subjects, 132 urine specimens.
• Who: five men and one woman aged 27 to 47; four used the inhaler as recommended for five days, two used double that dose for three days.
• How long: 3 to 5 days of dosing.
• Result: 17 specimens positive on the EMIT-d.a.u. class assay and none on the monoclonal assay; maximum l-desoxyephedrine 872 ng/ml in the recommended-dose group and 1,560 ng/ml at double dose; no positive specimen contained more than 200 ng/ml l-amphetamine.
• Funding: not stated.

No specimen was positive by the EM assay, whereas 17 specimens yielded positive EC results.

Saliva (oral fluid) testing can also read positive after labelled use of the inhaler, at rates that depend on the cut-off applied. (Source 10)

• Blood level study, Moderate certainty.
• Size: 16 participants given 7 doses per the manufacturer's recommendations.
• Who: adults in a controlled administration study, oral fluid collected with two devices plus an on-site screening device, plus plasma.
• How long: specimens before dosing and up to 32 hours after the first dose.
• Result: No positive on-site DrugTest 5000 results; at a 20-50 mcg/L methamphetamine cut-off with amphetamine at or above the limit of detection, 3.1-10.1% of specimens were positive, first positives after 1 to 4 doses.
• Funding: not stated.

In the cutoff range 20-50 μg/L methamphetamine with amphetamine ≥limit of detection, 3.1-10.1% of specimens were positive; first positive results were observed after 1-4 doses.

Inhaled levmetamfetamine produced small declines in stroke volume and cardiac output in healthy young adults, which the authors said suggest a possible cardiodepressant effect and could matter for someone whose heart already pumps poorly, although no case of heart failure linked to it had been reported. (Source 11)

• Blood level study, Very low certainty.
• Size: 12 healthy adults.
• Who: young normotensive adults with normal cardiovascular function.
• How long: measurements at 15 minutes and 2 hours within each dosing period.
• Result: The paper reports small declines in stroke volume and cardiac output at 15 minutes which it says suggest l-methamphetamine may have some cardiodepressant effects; heart rate did not change significantly but systemic vascular resistance increased by about 10%, maintaining blood pressure.
• Funding: independent (US Public Health Service / NIH grants)

For people with compromised ventricular function the negative inotropic effects of inhaled l-methamphetamine could become clinically significant; to date no reports of heart failure associated with l-methamphetamine have been reported.

The product's own label warns that repeated or prolonged use can make nasal congestion come back or get worse, and limits use to seven days. (Source 6)

• Official position, Certainty not rated.
• Size: not applicable.
• Who: people buying the inhaler over the counter in the US.
• How long: label in force in the version published 25 December 2024.
• Result: Seven-day limit on continuous use.
• Funding: not applicable.

do not use for more than 7 days use only as directed frequent or prolonged use may cause nasal congestion to recur or worsen

A 2025 pharmacology review describes rebound congestion and rhinitis medicamentosa after prolonged or excessive use of topical nasal vasoconstrictors as a class, while saying it is still unresolved how far this is specific to the imidazoline decongestants it focuses on. (Source 12)

• Expert review, not systematic, Low certainty.
• Size: not applicable (narrative review, no stated pooling method)
• Who: people using over-the-counter topical nasal decongestants.
• How long: not applicable.
• Result: No pooled rate given; the review reports progressively shorter response and a dependency on the decongestant.
• Funding: not stated.

However, misuse and deviation away from the recommended frequency of dose or maximum length of treatment can result initially in acute rebound congestion and if continued, rhinitis medicamentosa (RM).

The product's label tells anyone who is pregnant or breast-feeding to ask a health professional before using it. (Source 13)

• Official position, Certainty not rated.
• Size: not applicable.
• Who: people buying the inhaler over the counter in the US.
• How long: label version published 25 December 2024.
• Result: No rate or outcome given; the label states only that a health professional should be asked first.
• Funding: not applicable.

If pregnant or breast-feeding, ask a health professional before use.

What the evidence supports

Levmetamfetamine is listed by the FDA as a permitted topical nasal decongestant active ingredient for over-the-counter products, a regulatory position rather than trial evidence. (Source 2)

• Official position, Certainty not rated.
• Size: not applicable.
• Who: US over-the-counter drug products.
• How long: monograph in force in the 2024 annual revision.
• Result: Listed at paragraph (b)(1) under topical nasal decongestants; the section carries the source note [59 FR 43409, Aug. 23, 1994, as amended at 63 FR 40650, July 30, 1998; 71 FR 43362, Aug. 1, 2006].
• Funding: not applicable.

The active ingredient of the product consists of any of the following when used within the dosage limits and in the dosage forms established for each ingredient:

What the evidence does not support

A controlled human study of the inhaler found the delivered dose very small and the physiological effects minimal and not dose-dependent. (Source 14)

• Blood level study, Very low certainty.
• Size: 12 adults, no placebo arm.
• Who: normotensive adults aged 28 to 51 with no nasal pathology, not dependent on drugs other than caffeine or nicotine.
• How long: three ascending-dose sessions, each dosing over 8 hours, separated by at least a week.
• Result: Estimated delivered doses 74.0 +/- 56.1, 124.7 +/- 106.6 and 268.1 +/- 220.5 mcg for 16, 32 and 64 inhalations (mean 4.2 +/- 3.3 mcg per inhalation); plasma levels often below the limit of quantification.
• Funding: independent (US Public Health Service / NIH grants DA 012521, DA 018179, DA 012393)

Physiological changes were minimal and not dose-dependent. Small decreases in stroke volume and cardiac output suggesting mild cardiodepression were seen.

The same study did rate nasal stuffiness on a visual analogue scale, so congestion was measured; but its volunteers were screened to have no nasal pathology, and stuffiness was not among the ratings that changed, so the study cannot show whether the inhaler relieves a blocked nose. (Source 15)

• Blood level study, Very low certainty.
• Size: 12 adults, three ascending-dose sessions.
• Who: normotensive adults with no nasal pathology who had used no nasal decongestant for three months, so not congested.
• How long: ratings 15 minutes before the first dosing period, at 5 and 30 minutes within each period, and 4, 8, 18 and 30 hours after the last dose.
• Result: Table 4 of the full text gives nasal stuffiness an overall P value of 0.88 and nasal dryness 0.20, while the Results paragraph names Any Drug Effect, Bad Drug Effect, Dizziness, Good Drug Effect and headache as the ratings that rose; the two P values are table cells and so carry no contiguous quotation of their own.
• Funding: independent (US Public Health Service / NIH grants)

Items included Visual Analog Scale ratings of "any drug effect," "good drug effect," "bad drug effect," "nasal stuffiness," "nasal dryness," "headache," and "dizziness."

The authors of that study stated that no data at all had been published on the pharmacology of intranasal l-methamphetamine before theirs, and that over-the-counter nasal decongestants in general have surprisingly little published pharmacology. (Source 16)

• Blood level study, Very low certainty.
• Size: not applicable (statement of the evidence base in the introduction of a 12-person study)
• Who: not applicable.
• How long: not applicable.
• Result: No prior published pharmacology data identified by the authors.
• Funding: independent (US Public Health Service / NIH grants)

Despite the widespread use of OTC nasal decongestants, there is surprisingly little published data on their pharmacologic effects.

The study's own Results describe the rises in Bad Drug Effect and Dizziness as statistically significant across time but trivial and non-significant at peak, and the Good Drug Effect rise as reaching only 9.7 on a 0 to 100 scale. (Source 17)

• Blood level study, Very low certainty.
• Size: 12 adults who were not drug users.
• Who: non-drug-using normotensive adults.
• How long: three ascending-dose sessions, ratings across each session.
• Result: Any Drug Effect peak p < 0.01 and overall p = 0.001; Bad Drug Effect p = 0.01 and Dizziness p = 0.002 across time with peak effects called trivial and non-significant; Good Drug Effect p = 0.001 but only to 9.7 (13.0) on a 0-100 scale; headache p = 0.01 at 12.7 (17.0)
• Funding: independent (US Public Health Service / NIH grants)

VAS "Bad Drug Effect," (p = 0.01) and "Dizziness" (p = 0.002) both significantly increased across time with no significant differences between inhaler conditions but peak effects were trivial and non-significant.

Where the evidence is mixed

The same study read as low abuse potential for this product, but the authors noted that abuse of the inhaler has been reported in the literature and that larger intravenous doses of the l-isomer are psychoactive. (Source 3)

• Blood level study, Very low certainty.
• Size: 12 adults who were not drug users.
• Who: non-drug-using normotensive adults.
• How long: three dosing sessions.
• Result: Good Drug Effect rose by a change score of about 6 on a 0 to 100 scale in the 64-inhalation condition (from a mean of 5.8 to 9.7); the paper reports increases of a similar magnitude in Bad Drug Effect and Dizziness, whose peak effects it calls trivial and non-significant.
• Funding: independent (US Public Health Service / NIH grants)

Limit of this finding: The passage this finding comes from contains a printing error in the source itself: it gives the intravenous comparison doses as "0.5 mg/kg and 0.25 kg/kg i.v.", and 0.25 kg per kg of body weight is impossible. It is almost certainly meant to read 0.25 mg/kg. We have kept the source's words rather than correcting them, and nothing in this entry relies on that figure.

The 64-inhalation condition produced a small (change score of ~6) increase in "Good Drug Effect" suggesting a low potential for abuse even though occurrences of inhaler abuse is reported in the literature

That review is explicit that it has not been established how far its hypothesised mechanisms for rhinitis medicamentosa are a response to the imidazoline decongestants themselves or to the preservatives carried in topical nasal preparations, so it cannot be read as a measured rate for levmetamfetamine. (Source 7)

• Expert review, not systematic, Very low certainty.
• Size: not applicable.
• Who: people using over-the-counter topical nasal decongestants.
• How long: not applicable.
• Result: No effect estimate; the review states that how far the hypothesised mechanisms reflect the imidazolines themselves rather than the preservatives in topical nasal preparations is undetermined.
• Funding: not stated.

To which extent this is solely in response to the use of imidazoline derivates or related to the presence of preservatives in topical nasal treatments is yet to be determined.

Where the research disagrees

Whether a positive amphetamine screen can be explained away by an over-the-counter nasal inhaler

• US federal drug-testing practice, as verified by investigators at RTI International for the HHS workplace drug-testing programme (2012), laboratory verification of inhaler enantiomer content plus a proficiency-testing set for HHS-certified laboratories, supporting a 1991 Department of Health and Human Services Technical Advisory: "D-methamphetamine at more than 20% of the total is considered indicative of a source other than an OTC product." (Source 18)
• Controlled-dosing investigators (2014), controlled human administration study in 22 adults with enantiomer-specific GC-MS confirmation of every void: "The immunoassays had high efficiencies, but our first hypothesis was not affirmed." (Source 8)

How much

• Reference intake: There is no reference intake, because levmetamfetamine is a drug and not a nutrient. The amount is fixed by the product rather than by a prescriber: the Drug Facts label states what the inhaler delivers per 800 mL of air, how often it may be used and what is labelled for each age band, including that it is not for children under 2. (Source 19)
• Upper limit: No upper limit has been set by any nutrition body. The label's own ceiling is a frequency limit rather than a daily dose figure in mg, and a separate warning section caps continuous use at seven days. (Source 19)
• Studied: The 2008 pharmacology study had people take 16, 32 and then 64 inhalations in separate sessions, four dosing periods two hours apart, with all dosing in a session spread across 8 hours. (Source 20)
• Studied: The 2014 drug-testing study gave 22 adults one dose, described as two inhalations in each nostril, every 2 hours for 10 hours on the first day and a single dose on the second. (Source 4)
• Studied: The 2008 investigators also noted that estimates circulating in reference works implied a far larger daily exposure than they measured, and that they could not find the source data behind those figures. (Source 21)
• Studied: In that study the investigators estimated the delivered dose for the 16, 32 and 64 inhalation sessions at about 74.0, 124.7 and 268.1 mcg respectively, a mean of about 4.2 mcg per inhalation. (Source 14)

A common belief, and what the research shows

The belief: A medicated vapour inhaler is just menthol and camphor and has nothing to do with methamphetamine.

What the research shows: The decongestant in it is one of the two mirror-image forms of methamphetamine. The pharmacology paper states it directly: "There are two enantiomers of methamphetamine: dextrorotatory (d) methamphetamine and levorotatory (l) methamphetamine." The same paragraph says "Each Vicks inhaler contains about 50 mg of l-methamphetamine, and earlier estimates suggested delivered daily doses between 1.9 to 7.2 mg of drug when used as directed". That does not make it the street drug: the l-form produced minimal effects in the study, and controlled dosing found "No d-methamphetamine or d-amphetamine was detected in any urine specimen by GC-MS." But it is enough to show up on some drug screens.

Questions and answers

What is it?

Levmetamfetamine is a nasal decongestant drug sold over the counter, usually as a small plastic inhaler you sniff. Chemically it is one of the two mirror-image forms of methamphetamine, the left-handed one, which behaves very differently in the body from the right-handed form that is abused. The study we quote says each inhaler contains about 50 mg of it, mixed with menthol, camphor and oils, but the same paper's Methods report that the amount in new inhalers was highly variable, between 50 and 75 mg. (Source 22)

What does it do in the body?

It acts on the sympathetic nervous system indirectly, by making nerve endings release noradrenaline and dopamine and blocking their re-uptake. That is the same sort of signalling that narrows blood vessels, which is how a decongestant is supposed to shrink a swollen nasal lining. The pharmacology paper also notes that heavy repeated exposure to methamphetamine runs those chemical stores down instead. (Source 1)

Is it good or bad for you?

On the evidence available its benefit is essentially unmeasured and its measured effects are small. The one human study describes the inhaler as well tolerated, producing minimal pharmacodynamic effects even at four times the maximum recommended dose, but the same paper reports a rise in headache ratings in the highest-dose condition only, rises in bad-drug-effect and dizziness ratings across time with no significant difference between the inhaler conditions and peak effects the authors themselves call trivial and non-significant, blood-pressure increases of about 12 mmHg at most, and impedance-cardiography signs of mild cardiodepression. Two further things count against it, both recorded under harms in this entry with their own sources: the label's own warning that frequent or prolonged use can make congestion worse, and controlled-dosing studies in which labelled use made an amphetamine urine screen read positive. (Source 23)

How do you get more of it?

It is only available as a manufactured over-the-counter inhaler; there is no dietary or natural source. The Drug Facts label states how much the device puts out per 800 mL of air, that it is not to be used more often than every 2 hours, and sets out separate labelled amounts for adults and children 12 and over, for children 6 to under 12 with adult supervision, and says it is not for children under 2. Those are the manufacturer's labelled directions, recorded here as a position, not advice. (Source 19)

If it is harmful, what reduces it?

There is no antidote or clearance treatment in the literature we searched; exposure stops when the inhaler is put down. The label's own limit is seven days of use, and it warns that frequent or prolonged use can make congestion come back or worsen, which is the main reason stopping matters. If a drug screen has come back positive, what resolves that is a chiral confirmation test rather than anything done to the body - that point is recorded separately in this entry, with the drug-testing studies as its source. (Source 6)

Why might someone be low in it or missing it?

Nobody is low in levmetamfetamine. It is not made by the body and it is not a nutrient; it only exists in a person because they used a product containing it. The Drug Enforcement Administration's own notice describes it as the 50 mg content of a branded nasal decongestant inhaler, an over-the-counter non-narcotic drug product. (Source 24)

Which whole foods contain it or feed it?

None. No whole food contains it and nothing in the diet feeds it, because it is a synthetic drug substance loaded into a device. We searched Europe PMC for any food source or dietary occurrence of levmetamfetamine or l-desoxyephedrine and found none; what the literature describes is the content of the inhaler itself. (Source 22)

We searched: Europe PMC searches for levmetamfetamine, l-desoxyephedrine and intranasal l-methamphetamine; no paper describes a dietary or food source. The only source described is the manufactured inhaler.

What happens if you do not have it?

Nothing happens. There is no deficiency state, because the body has no use for it. The labelled purpose is only temporary relief of a blocked nose from a cold or an allergy, and no study we found looked at outcomes in people who do not use it. Given how little has been published even on whether it works, there is no basis for saying that going without it costs anything. (Source 16)

We searched: Europe PMC searches for levmetamfetamine efficacy and for nasal decongestant outcome trials; no study reports outcomes of not using it, and the one human pharmacology paper states the published pharmacology base was empty before 2008.

How can you test for it?

A urine drug test can show it. The problem is that a standard amphetamine screen cannot tell the two mirror-image forms apart, so a positive screen does not say which was used. US federal practice resolves that with a second, enantiomer-specific test: a result in which more than a fifth of the methamphetamine is the d-form is read as coming from something other than an over-the-counter inhaler. The same laboratory work found that optical impurity in the derivatising reagent made measured D-methamphetamine percentages consistently 1 to 3% higher than theoretical, in the source's own wording, and that laboratories can still apply the threshold reliably down to a total methamphetamine concentration of 250 ng/mL. (Source 18)

References

1. BMC Clinical Pharmacology. The clinical pharmacology of intranasal l-methamphetamine — Discussion, paragraph on stroke and mechanism of action. 2008. PMID 18644153, DOI 10.1186/1472-6904-8-4. Read the source
2. Code of Federal Regulations, US Government Publishing Office (govinfo). 21 CFR 341.20 Nasal decongestant active ingredients (2024 annual revision). 2024. Read the source
3. BMC Clinical Pharmacology. The clinical pharmacology of intranasal l-methamphetamine — Discussion, paragraph on isomeric differences and abuse potential. 2008. PMID 18644153, DOI 10.1186/1472-6904-8-4. Read the source
4. Journal of analytical toxicology. Methamphetamine and amphetamine isomer concentrations in human urine following controlled Vicks VapoInhaler administration — Abstract. 2014. PMID 25217541, DOI 10.1093/jat/bku077. Read the source
5. BMC Clinical Pharmacology. The clinical pharmacology of intranasal l-methamphetamine — Methods, paragraph on abstention from nicotine, caffeine and alcohol. 2008. PMID 18644153, DOI 10.1186/1472-6904-8-4. Read the source
6. DailyMed (US National Library of Medicine), SPL submitted by Walgreens; label version published 25 December 2024. Drug Facts label, levmetamfetamine vapour inhaler — the complete duration-of-use subsection of Warnings. 2024. Read the source
7. Frontiers in pharmacology. Part II - imidazolines and rhinitis medicamentosa: how can we tackle the rebound dilemma? — Abstract, later passage (continues from the sibling entry, whose closing sentence is not repeated here). 2025. PMID 41394157, DOI 10.3389/fphar.2025.1655254. Read the source
8. Journal of analytical toxicology. Methamphetamine and amphetamine isomer concentrations in human urine following controlled Vicks VapoInhaler administration — Abstract, later passage. 2014. PMID 25217541, DOI 10.1093/jat/bku077. Read the source
9. Therapeutic drug monitoring. Response of EMIT amphetamine immunoassays to urinary desoxyephedrine following Vicks inhaler use — Abstract. 1995. PMID 7725384, DOI 10.1097/00007691-199502000-00015. Read the source
10. Drug testing and analysis. Oral fluid with three modes of collection and plasma methamphetamine and amphetamine enantiomer concentrations after controlled intranasal l-methamphetamine administration — Abstract, later passage. 2015. PMID 25786659, DOI 10.1002/dta.1784. Read the source
11. BMC Clinical Pharmacology. The clinical pharmacology of intranasal l-methamphetamine — Discussion, paragraph on stroke volume and cardiac output. 2008. PMID 18644153, DOI 10.1186/1472-6904-8-4. Read the source
12. Frontiers in pharmacology. Part II - imidazolines and rhinitis medicamentosa: how can we tackle the rebound dilemma? — Abstract. 2025. PMID 41394157, DOI 10.3389/fphar.2025.1655254. Read the source
13. DailyMed (US National Library of Medicine); labeller Walgreen Company. Drug Facts label, levmetamfetamine vapour inhaler — the complete pregnancy or breast-feeding subsection of Warnings (SPL section code 53414-9). 2024. Read the source
14. BMC clinical pharmacology. The clinical pharmacology of intranasal l-methamphetamine — Results section of the abstract. 2008. PMID 18644153, DOI 10.1186/1472-6904-8-4. Read the source
15. BMC clinical pharmacology. The clinical pharmacology of intranasal l-methamphetamine — Measures > Subjective measures, paragraph on the visual analogue scales administered. 2008. PMID 18644153, DOI 10.1186/1472-6904-8-4. Read the source
16. BMC Clinical Pharmacology. The clinical pharmacology of intranasal l-methamphetamine — Background, second paragraph. 2008. PMID 18644153, DOI 10.1186/1472-6904-8-4. Read the source
17. BMC clinical pharmacology. The clinical pharmacology of intranasal l-methamphetamine — Results, paragraph on subjective effects. 2008. PMID 18644153, DOI 10.1186/1472-6904-8-4. Read the source
18. Journal of analytical toxicology. Evaluation of the 20% D-methamphetamine requirement for determining illicit use of methamphetamine in urine — Abstract. 2012. PMID 22586207, DOI 10.1093/jat/bks042. Read the source
19. DailyMed (US National Library of Medicine), SPL submitted by Walgreens; label version published 25 December 2024. Drug Facts label, levmetamfetamine vapour inhaler — the complete "Directions" section, with the two-column age-band/dose table serialised one row per line as "age band | dose". 2024. Read the source
20. BMC clinical pharmacology. The clinical pharmacology of intranasal l-methamphetamine — Methods, paragraph on the dosing schedule. 2008. PMID 18644153, DOI 10.1186/1472-6904-8-4. Read the source
21. BMC Clinical Pharmacology. The clinical pharmacology of intranasal l-methamphetamine — Discussion, paragraph on delivered doses. 2008. PMID 18644153, DOI 10.1186/1472-6904-8-4. Read the source
22. BMC Clinical Pharmacology. The clinical pharmacology of intranasal l-methamphetamine — Background, first paragraph. 2008. PMID 18644153, DOI 10.1186/1472-6904-8-4. Read the source
23. BMC clinical pharmacology. The clinical pharmacology of intranasal l-methamphetamine — Discussion, opening summary paragraph. 2008. PMID 18644153, DOI 10.1186/1472-6904-8-4. Read the source
24. Federal register. Schedules of Controlled Substances: Table of Excluded Nonnarcotic Products: Vicks® VapoInhaler® — the final rule's SUMMARY, as carried in the abstract field of the PubMed record. 2016. PMID 26859905. Read the source