Bupropion toxicity - Revision history

Elcatracho: /* Background */

2021-01-13T18:18:35Z

Background

← Older revision		Revision as of 18:18, 13 January 2021
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	==Background==		==Background==
	*[[Bupropion]] is a norepinephrine/dopamine reuptake inhibitor used for depression, ADHD, and smoking cessation		*[[Bupropion]] is a norepinephrine/dopamine reuptake inhibitor used for depression, ADHD, and smoking cessation
			*Structurally part of the [[Synthetic cathinone toxicity\|synthetic cathinones]]
	*Toxicity occurs with ingestion of >450mg/d		*Toxicity occurs with ingestion of >450mg/d

Elcatracho: /* External Links */

2021-01-13T18:16:16Z

External Links

← Older revision		Revision as of 18:16, 13 January 2021
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	==External Links==		==External Links==
	https://emcrit.org/toxhound/illbutrin/		*https://emcrit.org/toxhound/illbutrin/
			*https://emcrit.org/ibcc/bupropion/

	==References==		==References==
	<references/>		<references/>
	[[Category:Toxicology]]		[[Category:Toxicology]]

Elcatracho: /* Evaluation */

2021-01-13T18:15:22Z

Evaluation

← Older revision		Revision as of 18:15, 13 January 2021
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	*CBC, CMP		*CBC, CMP
	*[[ECG]] to eval for QRS and [[QT prolongation]]		*[[ECG]] to eval for QRS and [[QT prolongation]]
			**Typically does not lead to Torsades de Pointes<ref>Giroski, L., & Shih, R. (2012). QTC Prolongation and Torsades in Bupropion Overdoses Presenting to United States Emergency Departments. The Journal of Emergency Medicine, 43(5), 934–935. doi:10.1016/j.jemermed.2012.09.104 </ref>

	==Management==		==Management==

Elcatracho: /* Management */

2021-01-13T18:11:28Z

Management

← Older revision		Revision as of 18:11, 13 January 2021
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	*[[Sodium bicarbonate]] if QRS prolongation		*[[Sodium bicarbonate]] if QRS prolongation
	**May be unresponsive to bicarb<ref>Wills BK, Zell-Kanter M, Aks SE. Bupropion-associated QRS prolongation unresponsive to sodium bicarbonate therapy. Am J Ther. 2009;16(2):193-196. doi:10.1097/MJT.0b013e3180a5bd83</ref>as mechanism of QRS prolongation thought thought to be secondary to inhibition of gap junctions<ref>Caillier B, Pilote S, Castonguay A, et al. QRS widening and QT prolongation under bupropion: a unique cardiac electrophysiological profile. Fundam Clin Pharmacol. 2012;26(5):599-608. doi:10.1111/j.1472-8206.2011.00953.x</ref>		**May be unresponsive to bicarb<ref>Wills BK, Zell-Kanter M, Aks SE. Bupropion-associated QRS prolongation unresponsive to sodium bicarbonate therapy. Am J Ther. 2009;16(2):193-196. doi:10.1097/MJT.0b013e3180a5bd83</ref>as mechanism of QRS prolongation thought thought to be secondary to inhibition of gap junctions<ref>Caillier B, Pilote S, Castonguay A, et al. QRS widening and QT prolongation under bupropion: a unique cardiac electrophysiological profile. Fundam Clin Pharmacol. 2012;26(5):599-608. doi:10.1111/j.1472-8206.2011.00953.x</ref>
	*Intralipid for refractory cases		*Intralipid<ref>Sirianni AJ, Osterhoudt KC, Calello DP, et al. Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine. Ann Emerg Med. 2008;51(4):412-415.e1. doi:10.1016/j.annemergmed.2007.06.004</ref> or ECMO for refractory cases

	==Disposition==		==Disposition==

Elcatracho: /* Management */

2021-01-13T18:09:05Z

Management

← Older revision		Revision as of 18:09, 13 January 2021
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	*Early vasopressor and ionotropic agents for hemodynamic instability (Bupropion depresses myocardial contractility)		*Early vasopressor and ionotropic agents for hemodynamic instability (Bupropion depresses myocardial contractility)
	*[[Sodium bicarbonate]] if QRS prolongation		*[[Sodium bicarbonate]] if QRS prolongation
			**May be unresponsive to bicarb<ref>Wills BK, Zell-Kanter M, Aks SE. Bupropion-associated QRS prolongation unresponsive to sodium bicarbonate therapy. Am J Ther. 2009;16(2):193-196. doi:10.1097/MJT.0b013e3180a5bd83</ref>as mechanism of QRS prolongation thought thought to be secondary to inhibition of gap junctions<ref>Caillier B, Pilote S, Castonguay A, et al. QRS widening and QT prolongation under bupropion: a unique cardiac electrophysiological profile. Fundam Clin Pharmacol. 2012;26(5):599-608. doi:10.1111/j.1472-8206.2011.00953.x</ref>
	*Intralipid for refractory cases		*Intralipid for refractory cases

Elcatracho: /* See Also */

2021-01-13T18:00:06Z

Elcatracho: /* Background */

2020-11-26T01:09:57Z

Background

← Older revision		Revision as of 01:09, 26 November 2020
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	==Background==		==Background==
	*[[Bupropion]] is a norepinephrine/dopamine reuptake inhibitor ~~(structurally belongs to class of [[synthetic cathinones]])~~used for depression, ADHD, and smoking cessation		*[[Bupropion]] is a norepinephrine/dopamine reuptake inhibitor used for depression, ADHD, and smoking cessation
	*Toxicity occurs with ingestion of >450mg/d		*Toxicity occurs with ingestion of >450mg/d

Elcatracho: /* Background */

2020-11-26T01:09:16Z

Background

← Older revision		Revision as of 01:09, 26 November 2020
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	==Background==		==Background==
	*[[Bupropion]] is a norepinephrine/dopamine reuptake inhibitor used for depression, ADHD, and smoking cessation		*[[Bupropion]] is a norepinephrine/dopamine reuptake inhibitor (structurally belongs to class of [[synthetic cathinones]])used for depression, ADHD, and smoking cessation
	*Toxicity occurs with ingestion of >450mg/d		*Toxicity occurs with ingestion of >450mg/d

Beren85: /* Management */

2019-09-01T14:37:33Z

Management

← Older revision		Revision as of 14:37, 1 September 2019
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	==Management==		==Management==
	*~~[[GI decontamination]]~~		*Activated charcoal or gastric emptying are not indicated
	**Consider whole-bowel irrigation for sustained-release formulations		**Consider whole-bowel irrigation for sustained-release formulations
	*[[Seizure\|Seizure Treatment]]		*[[Seizure\|Seizure Treatment]]
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	**[[Barbiturates]] are 2nd line		**[[Barbiturates]] are 2nd line
	*Early vasopressor and ionotropic agents for hemodynamic instability (Bupropion depresses myocardial contractility)		*Early vasopressor and ionotropic agents for hemodynamic instability (Bupropion depresses myocardial contractility)
			*[[Sodium bicarbonate]] if QRS prolongation
	*Intralipid for refractory cases		*Intralipid for refractory cases

Beren85: /* Evaluation */

2019-09-01T14:35:59Z

Evaluation

← Older revision		Revision as of 14:35, 1 September 2019
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	==Evaluation==		==Evaluation==
	*CBC, CMP		*CBC, CMP
	*[[ECG]] to eval for [[QT prolongation]]		*[[ECG]] to eval for QRS and [[QT prolongation]]

	==Management==		==Management==

← Older revision		Revision as of 18:00, 13 January 2021
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	==See Also==		==See Also==
	*[[Bupropion]]		*[[Bupropion]]

			==External Links==
			https://emcrit.org/toxhound/illbutrin/

	==References==		==References==
	<references/>		<references/>
	[[Category:Toxicology]]		[[Category:Toxicology]]