A Fatal Case of Bupropion (Zyban(R)) Overdose

Abstract

A sensitive and reproducible method for the identification and the quantitative determination of bupropion (BUP) and its major metabolites, hydroxybupropion (OH-BUP) and threohydrobupropion (T-BUP), was developed in blood and urine. The three compounds were extracted with a solid-phase extraction procedure followed by LC-ESI-MS-MS separation and quantification using decadeuterated lidocaine as internal standard. BUP and its metabolites were satisfactorily identified by multiple reactions monitoring detection. The limits of detection and quantification were determined at 5 and 10 microg/L, respectively, for each analyte. The intraday and interday coefficients of variability were lower than 11.9% for BUP and its metabolites. This method was applied to the forensic case of a 35-year-old male who died after a suspected ingestion of 30 slow-release tablets of Zyban. As samplings were performed at least 72 h after the drug intake, BUP had disappeared from blood, but OH-BUP and T-BUP were present at the concentrations of 5.8 and 30.4 mg/L, respectively. In urine, concentrations ranged from 42.9 mg/L for BUP to 617 mg/L for T-BUP. These results agree with the hypothesis of a successful suicide attempt.

Bupropion Overdose Resulted in a Pharmacobezoar in a Fatal Bupropion (Wellbutrin®) Sustained‐release Overdose: Postmortem Distribution of Bupropion and its Major Metabolites

“…Bupropion, OH‐BUP, E‐BUP, and T‐BUP were quantified in intracranial blood at 1.9, 8.1, 7.3, and 59.3 mg/L, respectively. To date, there are few references to blood concentrations of BUP and its metabolites in cases of lethal intoxication . However, lethal blood concentrations are much higher than therapeutic concentrations (0.025–0.1 mg/L) and fatalities have been reported involving postmortem BUP blood levels ranging from 3.1 to >20 mg/L .…”

“…Although intentional overdose with BUP is not uncommon, actual deaths have been less frequently reported, with fatalities generally <0.5% (1)(2)(3)7). Little is known about toxicokinetics of bupropion, and very few reports of fatal overdose with postmortem bupropion blood and/or tissue concentrations appear in the literature (8)(9)(10)(11)(12).…”

Cardiac Arrest After Status Epilepticus: Bupropion and Ecstasy Intoxication

“…Bizim olgumuzda görülen nöbet ve kardiyak arrest muhtemelen ekstazi birlikteliği nedeniyle değil, bupropion dozunun plazmada artması sonucu olabilir (2). Bupropion yüksek dozu özellikle ajitasyon, halüsinasyon, tremor, nöbet gibi nörolojik semptomlara sebep olmaktadır; kardiyovasküler yan etkisi ise sinüs taşikardisi ile birlikte görülen QT mesafesinde uzama ve atriyoventriküler bloğa bağlı kardiyak arrest görülebilir (1,3). Literatürde status ve kardiyak arrest ile birlikteliği olan ve yüksek doz alım öyküsü olan olguların mortalitesi yüksek olarak belirtilmiştir (4,5).…”

High Performance Liquid Chromatographic Determination of Bupropion Using H-Clinoptilolite as a Sorbent for Plasma and Urine Purification

“…Bupropion (1-(3-chlorophenyl)-2-[(1,1-dimetylethyl)-amino]-1-propanone) is the wellknown antidepressant, overdose of which is accompanied with toxic effects, often fatal [19].…”