Naphazoline abuse: a rare case of myocardial infarction with nonobstructive coronary arteries.

Abstract

Nasal vasoconstrictors are some of the most widely used over-the-counter drugs, considered by many consumers as relatively safe with few significant adverse effects. At recommended dosage, the drug produces local vasoconstriction in nasal mucous membranes. However, the use of such drugs has been linked to cardiovascular adverse effects, including hypertension, arrhythmias, prolongation of the QT interval, and angina pectoris. 1 The various cardiovascular adverse effects may occur with both oral and nasal administration and after a single dose or prolonged treatment, without dose-effect and independently of vascular status and age. 2 Although the effects of ephedrine and pseudoephedrine have been widely studied, the effects of naphazoline are less well known. We describe the case of a previously healthy man who experienced a MINOCA (myocardial infarction with nonobstructive coronary arteries) after abuse of recommended dose of naphazoline. To our knowledge, this is the first time that a strict temporal relation between the occurrence of MINOCA and topical naphazoline abuse is being described.