Why do athletes use smelling salts, and why is the NFL banning them?

Raiders defensive end Maxx Crosby (98) uses smelling salts during a 2023 game against the Los Angeles Chargers in Las Vegas. Photo by: David Becker / AP, file

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The NFL sent a memo to teams Tuesday banning all forms of ammonia inhalants and smelling salts from games, pregame activities and halftime, following an FDA warning about their unproven safety and efficacy. The decision stems from concerns that these products, which have been ubiquitous on NFL sidelines for years, may obscure neurological symptoms that could indicate concussion.

What are smelling salts?

Smelling salts are chemical compounds, most commonly containing ammonium carbonate or a blend of ammonia, water and alcohol. When exposed to air, they release ammonia gas, which has a pungent, acrid smell reminiscent of strong household cleaners. Sometimes, fragrances like lavender or eucalyptus are added to soften the harsh odor [1].

What is the effect of smelling salts?

Smelling salts trigger the fight-or-flight response through a specific physiological mechanism. When a person inhales the vapors, the ammonia gas irritates the membranes of the nose and lungs, triggering an inhalation reflex. This causes a sudden, deep breath and stimulates the sympathetic nervous system [2].

The process follows this chain of events:

• Ammonia vapors irritate nasal and lung membranes
• This triggers an inhalation (startle) reflex
• The body increases breathing rate and oxygen intake
• The sympathetic nervous system is activated, releasing adrenaline
• The individual experiences the physiological effects of the fight-or-flight response: increased heart rate, alertness, and energy [3]

The sympathetic nervous system activation signals the adrenal glands to release adrenaline (epinephrine) and other stress hormones. These hormones increase heart rate, blood pressure and blood flow to the muscles, enhancing alertness and preparing the body to respond to perceived threats or intense physical demands [2].

What are they used for?

• Traditional medical use: Historically, smelling salts were used to revive people who fainted or felt light-headed.
• Athletes: Modern use is prevalent in sports like football, hockey, powerlifting and rugby. Athletes use them for a temporary mental jolt or alertness before big efforts. However, they are now banned in boxing [4].
• First aid: Occasionally, they’re still used in first aid kits to revive people who have fainted or are at risk of fainting [1].

Why are some sports banning smelling salts?

The NFL and other sports organizations have banned smelling salts because they can mask the symptoms of a concussion or other traumatic brain injury. By stimulating alertness, ammonia inhalants might temporarily override or hide the warning signs of brain trauma, such as confusion, dizziness or loss of consciousness [5].

How they mask concussion symptoms

Smelling salts can mask concussion symptoms by temporarily increasing alertness and energy, potentially overriding the body’s natural signals of injury. The artificial boost in alertness does not address the underlying brain injury but can briefly suppress symptoms or give the impression of improvement, causing athletes to feel well enough to continue activity when they should be medically evaluated or removed from play [2].

This masking effect can:

• Temporarily hide concussion symptoms by making individuals feel “better” or more alert [1]
• Cause both the athlete and staff to underestimate the severity of the injury, delaying appropriate diagnosis and treatment [6]
• Increase the risk of more serious injury by facilitating a premature return to activity [7]

Because concussion protocols often rely on observing an athlete’s responsiveness, alertness and symptoms, the altered state caused by smelling salts can mislead medical staff, leading to inaccurate assessments and improper clearance to return [8].

Legal status and availability

You can legally purchase smelling salts in the United States, though regulations specify that they are only intended for use as a first aid agent — primarily to revive people who have fainted — and not for performance enhancement or general alertness.

Where to buy:

• Online retailers: Available through brand websites (Jujimufu, Westside Barbell, Zone Smelling Salts USA), Amazon, and specialty sites [9]
• Major online marketplaces: Walmart.com carries several brands and packaging options [10]
• First aid suppliers: Medical and first aid equipment sites often carry single-use ampules or bulk packs [11]
• Some pharmacies: Sometimes available over-the-counter in physical pharmacies, though less common than online [12]

Typical cost:

• Single-use ampule packs: Approximately $10-$15 for a 10-pack
• Larger bottles: Usually $15-$30 per bottle, depending on size and potency [13]

FDA guidelines and legal considerations

The FDA has warned against purchasing or using certain “energy alertness” ammonia inhalant products because these are considered unapproved drugs, and their safety and efficacy have not been demonstrated. The FDA has issued warnings to some brands for marketing smelling salts for performance enhancement [14].

Alternatives to smelling salts

Several alternatives can effectively boost alertness or revive someone, both naturally and safely:

• Cold water: Splashing cold water on your face or the back of your neck can instantly jolt your senses and increase alertness [15].
• Physical activity: Quick exercises such as jumping jacks, brisk walking or stretching get blood flowing and quickly increase oxygen to the brain, raising alertness levels [16].
• Rehydration: Dehydration can cause fatigue and grogginess. Drinking a glass of cold water can help restore energy and mental clarity [1].
• Nutritious snacks: Eating a small snack with a balance of complex carbohydrates and protein (like almonds or peanut butter on whole grain toast) can offer a rapid energy boost without the crash from sugary foods [17].
• Upbeat music: Listening to energizing music and even dancing briefly can sharpen mental focus and provide a mental reset [15].

Smelling salts provide a short-term boost in alertness via a physical respiratory reflex but have significant risks when used to “override” symptoms of head trauma. While they are easily accessible and inexpensive, they are losing favor in clinical and athletic settings due to safety concerns and lack of proven benefits for performance or cognitive enhancement. The potential for masking serious medical conditions, particularly concussions, has led to bans in major sports organizations. For those seeking alertness boosts, safer alternatives such as cold water, physical activity and aromatic stimulants offer effective options without the associated risks [4].