Imidazole decongestants are present in a variety of over-the-counter medications, including eye drops and nasal sprays. Their primary mechanism of action is vasoconstriction, accomplished by direct stimulation of alpha receptors on blood vessels. Accidental and intentional poisonings involving these substances are increasing, and can cause mental status and respiratory depression, as well as other effects related to alpha receptor stimulation. We present a case of tetrahydrozoline ingestion in an adult who presented with chest pain, bradycardia, mental status depression, miosis, and other signs and symptoms of imidazole compound poisoning. It is important for physicians to be familiar with the adverse effects of these ingestions and to be aware of the potential therapies for management.