![]() ![]() In this study, 52% of patients had episodes of tachycardia, 24% had ECG changes, the most common being QT and QRS prolongation, and 17% had seizures.Ĭo-ingestion with benzodiazepines decreased the odds of having a seizure (OR 0.32) however, the role of treating bupropion overdose patients with prophylactic benzodiazepines is unclear. A retrospective chart review of bupropion exposures reported to the Ontario Poison Centre between 20 analyzed 1,065 overdoses. Overall, the risk of death from bupropion toxicity is relatively low, with eight reported deaths from US poison center data in 2020 despite almost 17,000 reported cases. ![]() Patients should be symptom-free at the time of discharge. All bupropion XL overdoses, including therapeutic errors, should be observed for 24 hours for delayed-onset seizures. Patients with seizures, hemodynamic instability or life-threatening arrhythmias, and severely altered mental status be monitored in an ICU setting. Treatment of refractory cardiogenic shock and cardiopulmonary arrest can include veno-arterial extracorporeal membrane oxygenation (VA ECMO). Classically, ILE is used as rescue therapy, but these cases may suggest value in earlier initiation. ILE has been shown in case reports to cause rapid improvement in hemodynamic status and left ventricular ejection fraction in overdose. Interestingly, ILE was not recommended in pulseless electrical activity due to the possibility of interference with epinephrine and extracorporeal treatments. The task force favored traditional treatments of seizures, such as benzodiazepines and phenobarbital, as first-line modalities. A clinical toxicology task force in 2016 supported intravenous lipid emulsion (ILE) in severe life-threatening toxicity, such as refractory status epilepticus or hemodynamic instability. Ĭardiogenic shock should be treated with vasopressors as first-line therapy. Unfortunately, bupropion-induced QRS prolongation may not respond to sodium bicarbonate since the cardiotoxicity does not appear to be due to fast sodium channelopathy and results from impaired gap junction communication. In the setting of wide QRS with hemodynamic instability or dysrhythmias, boluses of sodium bicarbonate are typically indicated. Widened QRS complex on the electrocardiogram often suggests fast sodium channel blockade. Life-threatening arrhythmias should be treated following ACLS guidelines, possibly including other adjuncts depending on the clinical situation. Avoidance of other anti-epileptics, including phenytoin, is recommended, given possible drug-drug interactions. Seizures should be treated with benzodiazepines as first-line agents and barbiturates, such as phenobarbital, as second-line agents. Unintentional overdose rarely causes significant clinical effects however, major adverse reactions (seizures) have been reported even in double-dose ingestions. Decontamination with activated charcoal may be appropriate for patients presenting soon after a large overdose and who do not need airway protection. ![]() Consultation with a regional poison center or toxicologist may be helpful, especially in critical cases with serious organ-system dysfunction. Primary management of bupropion overdose is supportive care, as no direct antidote exists. Status epilepticus, life-threatening arrhythmias, and cardiogenic shock have all been reported in overdose. The extended-release formulation has also been associated with delayed seizures for up to 24 hours after ingestion. Overdose is frequently associated with seizures, tachycardia, and agitation. The risk of seizures with daily doses below 300 mg is estimated at 0.1% but increases to 0.4% with doses up to 450 mg daily. The drug is now contraindicated in patients with seizure history, eating disorders, or those undergoing ethanol or CNS depressant withdrawal. Bupropion was withdrawn in 1986 after new-onset seizures were reported in a small portion of bulimic patients however, it was reintroduced in 1989 at lower dose ranges. Īdverse drug effects with therapeutic dosing are nonspecific and may include dry mouth, constipation, headache, nausea, agitation, insomnia, and weight loss. Multiple formulations exist, including immediate-release (IR), sustained-release (SR), and extended-release (XL). It is currently FDA-approved for treating major depressive disorder, seasonal affective disorder, and smoking cessation with several off-label uses, including sexual dysfunction secondary to antidepressant use, generalized anxiety disorder, ADHD, and bipolar disorder. Bupropion hydrochloride is an antidepressant drug belonging to the aminoketone class first introduced in 1985. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |