Bupropion Overdose
Bupropion (Wellbutrin, Zyban, Aplenzin)
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Mechanism: Dopamine/norepinephrine reuptake inhibitor, related to amphetamines
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Uses: depression, bipolar depression, ADHD, SSRI-induced sexual dysfunction, smoking cessation
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Dose adjusted for renal/hepatic impairment (processed in liver)
Side effects
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CNS stimulation, increased energy, anxiety, nervousness, tremors, panic
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Cases of new onset seizures with therapeutic doses of bupropion!
Mild - Moderate Overdose
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Agitation, hallucinations, tachycardia, tremors
Severe Overdose
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Seizures, status epilepticus, hypotension, QRS widening, QT prolongation, coma, ventricular tachyarrhythmias, death
Treatment
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Mainly supportive, make take days for bupropion to metabolize
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Benzos, benzos, benzos are first line
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May need intubation and propofol infusion
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EEG to monitor seizures and avoid incorrect diagnosis of brain death (can mimic)
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Vasopressors if needed
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ECMO is severe, refractory cases
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Charcoal if you catch it early enough and aspiration risk is low
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Consider whole bowel irrigation
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Maybe lipid emulsion
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Avoid phenytoin/phenobarb due to their own cardiovascular side effects
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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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