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A 78-year-old female with a history of stable angina, phoned for advice with chest pains following the application of 0.5% ephedrine nasal drops for nasal congestion, which she had bought over-the-counter on the recommendation of a pharmacist. On applying the medication, she developed chest pain which she recognised as her angina. The Foundation Year 2 general practitioner on duty consulted the British National Formulary (BNF), issue 56 and thought that nasal decongestant induced angina was unlikely and advised the patient to seek emergency attention should she have any further episodes. After re-applying the medication and suffering the same symptoms, the patient later presented to the Emergency Department. The patient had the relevant tests and was diagnosed with 'ephedrine-induced angina'. This settled on withdrawal of the medication and she had no further episodes of chest pain in the following 6 months.

An unusual case of systemic cardiovascular side effects from the application of over-the-counter nasal decongestion drops