Bupropion Overdose

Mon, 07/12/2021 - 5:00am
Author: 
Valeria Chew
Editor: 
Alison Jaworski, MD

Bupropion (Wellbutrin, Zyban, Aplenzin) 

  • Mechanism: Dopamine/norepinephrine reuptake inhibitor, related to amphetamines 

  • Uses: depression, bipolar depression, ADHD, SSRI-induced sexual dysfunction, smoking cessation 

  • Dose adjusted for renal/hepatic impairment (processed in liver) 

 

Side effects 

  • CNS stimulation, increased energy, anxiety, nervousness, tremors, panic 

  • Cases of new onset seizures with therapeutic doses of bupropion! 

 

Mild - Moderate Overdose 

  • Agitation, hallucinations, tachycardia, tremors 

 

Severe Overdose 

  • Seizures, status epilepticus, hypotension, QRS widening, QT prolongation, coma, ventricular tachyarrhythmias, death 

 

Treatment 

  • Mainly supportive, make take days for bupropion to metabolize 

  • Benzos, benzos, benzos are first line 

  • May need intubation and propofol infusion 

  • EEG to monitor seizures and avoid incorrect diagnosis of brain death (can mimic) 

  • Vasopressors if needed 

  • ECMO is severe, refractory cases 

 

  • Charcoal if you catch it early enough and aspiration risk is low 

  • Consider whole bowel irrigation 

  • Maybe lipid emulsion 

 

  • Avoid phenytoin/phenobarb due to  their own cardiovascular side effects 

  • No strong evidence that keppra prevents bupropion seizures 

 

 

 References:

 

Overberg, Adam et al. “Toxicity of Bupropion Overdose Compared With Selective Serotonin Reuptake Inhibitors.” Pediatrics vol. 144,2 (2019): e20183295. doi:10.1542/peds.2018-3295 

 

Stall, Nathan et al. “Bupropion abuse and overdose” CMAJ September 16, 2014 186 (13) 1015; DOI: https://doi.org/10.1503/cmaj.131534 

 

Farkas, Josh. EMCRIT - Bupropion intoxication. EMcrit Blog. Published on November 14, 2019. Accessed on June 21, 2021.  

  

Lexicomp. (n.d.). Bupropion: Drug information. UpToDate. Retrieved June 21, 2021, from https://www.uptodate.com/contents/bupropion-drug-information 

 

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