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Nitrous oxide can oxidize and inactivate vitamin B12, creating a functional deficiency even when the blood B12 level looks normal. This can disrupt nerve function and raise methylmalonic acid and homocysteine.

Nitrous oxide misuse involves inhaling the gas for intoxication, often from whipped-cream chargers called “whippets.” Repeated or heavy use can inactivate vitamin B12 and cause serious neurologic injury.

Both gabapentin and pregabalin can be misused and can cause dependence, but research generally finds stronger misuse signals for pregabalin, particularly among people with other substance use disorders.

Pregabalin can be misused and can cause physical dependence and withdrawal. Misuse risk appears higher in people with other substance use disorders, particularly opioid use disorder.

Gabapentin can be misused and, in some people, repeated use can lead to dependence and withdrawal. Risk is higher in people with other substance use disorders and when gabapentin is combined with opioids or other sedatives.

Phenibut is an unapproved GABA-B receptor agonist sold online as a supplement or nootropic. Repeated use can lead to dependence, and abrupt discontinuation can cause severe withdrawal including agitation, hallucinations, delirium, and seizures.

Designer benzodiazepines are unapproved benzodiazepine-like drugs sold in illicit markets. Their uncertain potency, hidden presence in counterfeit pills, and interaction with opioids or other depressants can make them dangerous.

Bromazolam is an illicit designer benzodiazepine increasingly found in counterfeit pills and mixed-drug overdoses. It can cause profound sedation, impaired coordination, and respiratory depression, especially with opioids.

Cychlorphine is an emerging non-fentanyl synthetic opioid detected in the illicit drug supply. Its high potency, hidden presence in fentanyl mixtures or counterfeit pills, and overdose risk are raising public-health concern.

Naloxone does not reverse xylazine or medetomidine themselves, but it should still be given when an overdose may involve opioids because these sedatives are commonly mixed with fentanyl and naloxone can reverse the opioid component.