Published: August 2009

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Nitrous oxide - side effects reminder

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Prescriber Update 30(3): 20
August 2009

Prescribers are reminded that prolonged use of nitrous oxide has been associated with neurological and haematological side effects such as megaloblastic anaemia and myelopathy due to inactivation of vitamin B₁₂. Neurological symptoms can occur without any overt haematological changes.

Where possible, prescribers are advised:

• To check vitamin B₁₂ levels in those with risk factors for vitamin B₁₂ deficiency prior to using nitrous oxide and to seek specialist advice if necessary.
• Not to use nitrous oxide continuously for more than 24 hours or more frequently than every 4 days without clinical supervision and haematological monitoring.