If a recently reported case is a reliable indicator, the over-the-counter medication pseudoephedrine can cause a heart attack - even in healthy young adults.

Dr. Alex F. Manini and colleagues at Harvard Medical School in Boston treated a 32-year-old man who experienced severe chest pain 45 minutes after taking two tablets of an over-the-counter cold remedy containing pseudoephedrine and acetaminophen.

The diagnosis of an acute heart attack was made based on laboratory testing, the team reports in the Annals of Emergency Medicine. Further tests showed that the heart muscle had been damaged by the event.

Prior to this episode, the man had been in good health except for a cold, Manini’s group explains. Cardiac catheterization showed that his coronary arteries were normal, and there was no history of heart disease or sudden death in his family.

“This case highlights a potential danger of pseudoephedrine even when used by otherwise healthy people,” the researchers note. They say doctors should advise their patients to be cautious when they take pseudoephedrine or similar drugs.

Drug-related adverse reactions are a common cause of illness and are among the top ten causes of death, Dr. E. Martin Caravati, of the University of Utah in Salt Lake City, points out in an accompanying editorial. In a recent study, pseudoephedrine was found to be the fourth most commonly used over-the-counter drug, surpassed only by pain medications.

Therefore, he says, doctors should perform complete medication reviews with their patients - including dietary supplements, over-the counter medications and herbal remedies.

SOURCE: Annals of Emergency Medicine, November 22nd online edition, 2004.