Bupropion Toxicity

Excerpt

Bupropion hydrochloride is an antidepressant drug belonging to the aminoketone class first introduced in 1985. It is currently FDA-approved for treating major depressive disorder, seasonal affective disorder, and smoking cessation with several off-label uses, including sexual dysfunction secondary to antidepressant use, generalized anxiety disorder, ADHD, and bipolar disorder. Multiple formulations exist, including immediate-release (IR), sustained-release (SR), and extended-release (XL).

Adverse drug effects with therapeutic dosing are nonspecific and may include dry mouth, constipation, headache, nausea, agitation, insomnia, and weight loss. Bupropion was withdrawn in 1986 after new-onset seizures were reported in a small portion of bulimic patients; however, it was reintroduced in 1989 at lower dose ranges. The drug is now contraindicated in patients with seizure history, eating disorders, or those undergoing ethanol or CNS depressant withdrawal. The risk of seizures with daily doses below 300 mg is estimated at 0.1% but increases to 0.4% with doses up to 450 mg daily.

Overdose is frequently associated with seizures, tachycardia, and agitation. The extended-release formulation has also been associated with delayed seizures for up to 24 hours after ingestion. Status epilepticus, life-threatening arrhythmias, and cardiogenic shock have all been reported in overdose.