Sustained-Release Bupropion Overdose: A Case Report

Abstract

Bupropion is an atypical antidepressant with a unique aminoketone structure similar to amphetamines. A narrow therapeutic margin is evident from observational studies that show seizure activity with doses of 400-600 mg or higher. A 38-year old woman took an overdose of 6 grams of bupropion with 110 grams of alcohol. She presented to the Emergency Department with agitation, visual hallucinations and myoclonus of the upper limbs; eyes spontaneously open with isochoric and light reactive pupils with horizontal nystagmus; afebrile, normotensive (121/63 mm Hg) and tachycardic (120 beats/minute). The electrocardiogram revealed a sinus tachycardia with prolonged QT interval (QT/QTc: 0.46/ 0.537) and a QRS complex length in the upper limit of normal. Arterial blood gases revealed metabolic acidosis (pH = 7.16) with increased anion-gap (value=18). She developed mal epilepticus needing thiopental induced coma and Intensive Care Unit (ICU) admission. She suffered prolonged symptoms including seizures before fully recovering. The narrow therapeutic range and the increasing use in the treatment of smoking cessation boosted the number of intentional and unintentional poisoning by this drug. Previous reports of Mendonça et al.; IJMPCR, 3(2): 38-43, 2015; Article no.IJMPCR.2015.033 39 bupropion overdose almost all involve the immediate release formulation. There are some reports of overdose with sustained-release formulation, but there is limited information on its spectrum of toxicity. Case Report

Bupropion-Induced Myoclonus: Case Report and Review of the Literature

“…Two cases of the overdosed individuals needed gastric lavage and/or activated charcoal administration to reduce the absorption of the massive, ingested dose. 14,15 At least 1 anti-epileptic drug was prescribed to control abnormal movements in 7 cases. Clonazepam, lorazepam, and levetiracetam were the antiepileptic drugs that were most used.…”

“…It was controlled with thiopental-induced coma. 14 Cyproheptadine was prescribed in 2 cases. Sodium bicarbonate was prescribed in 1 case of serotonin syndrome with metabolic acidosis.…”

“…In 3 of them, the symptoms developed within 1 to 2 hours. [12][13][14][15] Discontinuation of bupropion was the basic management in all cases. Two cases of the overdosed individuals needed gastric lavage and/or activated charcoal administration to reduce the absorption of the massive, ingested dose.…”

Nonepileptic Myoclonus Following Bupropion Overdose

“…4 Other neurologic effects of overdose reported include tremors, 5 agitation, 5 and hallucinations. 6 Myoclonus has been mentioned in only 1 case report 13 following bupropion overdose; however, the ingestion was mixed with multiple substances, including alcohol, and it was unknown if the myoclonus was epileptic in origin.…”

Bupropion Overdose and Acute Renal Failure

“…The narrow therapeutic range boosted the number of intentional and unintentional bupropion poisoning. 2 We aim to present a case of acute renal failure because of bupropion overdose, a toxic effect that has not been mentioned in the literature before.…”