Bupropion toxicity: Difference between revisions
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Revision as of 01:13, 24 July 2017
Background
- Bupropion is a norepinephrine/dopamine reuptake inhibitor used for depression, ADHD, and smoking cessation
- Toxicity occurs with ingestion of >450mg/d
Clinical Features
- Agitation
- Dizziness
- Tremor
- Nausea/vomiting
- Drowsiness/lethargy
- Tachycardia
- Seizure
- May develop in isolation from other symptoms
- Develops within first 1-4hr for regular-release, up to 8hr for delayed release forms
- Hypotension and cardiogenic Shock
Differential Diagnosis
Evaluation
- CBC, CMP
- ECG to eval for QT prolongation
Management
- GI decontamination
- Consider whole-bowel irrigation for sustained-release formulations
- Seizure Treatment
- Benzos are 1st line
- Barbiturates are 2nd line
- Early vasopressor and ionotropic agents for hemodynamic instability (Bupropion depresses myocardial contractility)
- Intralipid for refractory cases
Disposition
- Consider discharge if asymptomatic after 8hr for regular-release ingestions