Vicks Vapor Inhaler (Procter & Gamble) is an over-the-counter (OTC) decongestant. A patient who uses or abuses a Vicks Vapor Inhaler may have a positive urine drug test.
Active ingredient: levmetamfetamine (l-methamphetamine, formerly termed desoxyephedrine; d-methamphetamine is the form commonly abused)
Findings in a patient who has used a Vicks Vapor inhaler:
(1) The maximum amphetamine concentration after routine use is usually < 500 ng/mL (so a positive test is unusual using 1,000 ng/mL as the cutoff).
(1) With d-isomer and l-isomer differentiation, > 80% will be the l-isomer.
(2) The ratio of l-methamphetamine to l-amphetamine will usually be > 8.
Differential diagnosis:
(1) use of selegiline (Eldepryl)
(2) abuse of synthesized street methamphetamine
(3) abuse of the Vicks inhaler (while at low doses levmetamfetamine has mainly peripheral effects it can have CNS effects at high doses)
(4) contamination of a urine sample with levmetamfetamine to mask amphetamine abuse
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