Drug-induced chest pain and myocardial infarction. Reports to a national centre and review of the literature.
OBJECTIVE
To analyse reports of drug-induced myocardial infarction and chest pain sent to a national reporting centre. To review which drugs were suspected of exhibiting these adverse events and what mechanisms were involved.


METHODS
During the 20-year period 1975 through 1994, a total of 19,141 reports on adverse reactions to drugs were received by the Netherlands Centre for Monitoring of Adverse Reactions to Drugs. Of these 19,141 reports, 220 (1.1%) were concerned with drug-induced chest pain or myocardial infarction. After excluding reports in which the causal relationship was unlikely, poorly documented reports and reports on cases of overdosage, 183 reports (84%) were analysed.


RESULTS
There were 130 reports (71%) of drug-induced chest pain and 53 reports (29%) of drug-induced myocardial infarction. A total of 104 reports concerned females (57%). The most frequently reported suspected drugs were the antimigraine drug sumatriptan (33 reports, 4 concerning myocardial infarction), the calcium antagonist nifedipin (9 reports, 2 of myocardial infarction) and nicotine [9 reports (8 patches, 1 chewing gum), 5 concerning myocardial infarction]. There were 18 reports of a fatal outcome.


CONCLUSIONS
Several drugs can produce chest pain or myocardial ischaemia. It is important to recognise drugs as a potential cause, especially in patients with normal coronary arteries.
Ottervanger
J P
JP
Department of Internal Medicine II, University Hospital Dijkzigt, Rotterdam, The Netherlands.
Wilson
J H
JH
Stricker
B H
BH
D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data*; D000787:Angina Pectoris / Q000139:chemically induced*; D002121:Calcium Channel Blockers / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000139:chemically induced*; D009426:Netherlands; D009543:Nifedipine / Q000009:adverse effects*; D018170:Sumatriptan / Q000009:adverse effects; D014662:Vasoconstrictor Agents / Q000009:adverse effects
D002121:Calcium Channel Blockers; D014662:Vasoconstrictor Agents; D018170:Sumatriptan; D009543:Nifedipine