Bupropion toxicity

Background

• Uses
  • Antidepressant
  • Smoking cessation
  • ADHD
• Inhibits reuptake of norepinephrine and dopamine
• Toxicity occurs with ingestion of >450mg/d

Clinical Features

• Agitation
• Dizziness
• Tremor
• Nausea/vomiting
• Drowsiness
• 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

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
  • Barbituates are 2nd line

Disposition

• Consider discharge if asymptomatic after 8hr for regular-release ingestions