It is an important differential diagnosis for patients presenting with central cyanosis that does not respond to oxygen therapy[5–7,9]. [ejcrim.com]

[…] they easily obtained the drug from physicians under the pretense of seeking an antidepressant or smoking cessation aid.3 Emerging reports also highlight bupropion misuse in correctional facilities.5 Bupropion toxicity should be considered in patients presenting [cmaj.ca]

Initial lactate was 5.1 and a leukocytosis was present to 11.6, likely secondary to seizure activity. [acep.org]

Although seizures have been reported with therapeutic doses of bupropion, there are few reports presenting development of status epilepticus due to bupropion intoxication with different doses. [vlibrary.emro.who.int]

One patient presented twice and only one admission was included. For 19 of the 45 patients bupropion was the only drug ingested. [mja.com.au]

• Cerebral Palsy

  One of these patients had a history of cerebral palsy and was excluded because of predisposition to seizures. [mja.com.au]

• Falling

  Diazepam 2.5 – 5 mg every 5 minutes IV until gentle sedation is achieved and a heart rate falls towards 100 beats per minute is considered safe. If intubated see FASTHUGSINBED for further supportive care. [litfl.com]

• Asymptomatic

  A study of 114 children showed that 92% were asymptomatic, with most children taking less than two tablets.15 Our study supports this, with only one child becoming symptomatic. [mja.com.au]

• Overeating

  With overdoses over ~~3 grams, seizures become increasingly likely (Rusnyak 2018, 19857406). [emcrit.org]

  Prior to the cooling process, a continuous electroencephalogram (cEEG) revealed a burst suppression pattern which remained unchanged over a 2-day recording period. [e-jnc.org]

  The recommended dose is 1–2 mg/kg administered intravenously over 5 minutes that can be repeated with 1-hour intervals up to the maximum of 7 mg/kg[5,7]. Treatment with methylene blue is not effective in cases of low NADPH[11]. [ejcrim.com]

  Discussion Bupropion SR overdose caused significant effects, including seizures, in over a third of cases. [mja.com.au]

• Tachycardia

  Other common effects in the 19 patients who took bupropion alone included tachycardia (83%), hypertension (56%), agitation (32%) and gastrointestinal symptoms (37%). [mja.com.au]

  Children: >10 mg/kg requires assessment and observation in hospital Supportive Care Agitation and tachycardia: titrated doses of benzodiazepine. [litfl.com]

  Wide complex tachycardia after bupropion overdose. Am J Emerg Medicine. 2015;33:1540.e3-1540.e5. Return to Newsletter [acep.org]

  Electrocardiogram immediately after cardiac arrests showing sinus tachycardia and new first degree atrioventricular block with slight QRS prolongation. [e-jnc.org]

  Levels of methaemoglobin below 2% are not harmful[5,6], levels above 20% are associated with dyspnoea, tachycardia, headache and lethargy, and levels above 55% are life-threatening. [ejcrim.com]

• Suggestibility

  Early studies of bupropion suggested it was less cardiotoxic than other antidepressants, and this was supported in the study of overdoses with the IR formulation.10 More recently, two cases were reported suggesting cardiotoxicity based on a prolonged [mja.com.au]

  […] well-tolerated; however, common adverse effects include dry mouth, nausea, agitation and insomnia.1 Bupropion abuse is a growing public health problem Although bupropion shares some structural and pharmacologic properties with amphetamine, early research suggested [cmaj.ca]

  Outpatient pharmacy records corroborated a recently dispensed 30 day supply of bupropion SR 200 mg to be taken every 12 hours; this suggests an approximate ingestion dose of 12 g. [e-jnc.org]

  EEG indicated lowered seizure threshold with propensity for focal seizures in the right temporal region and was suggestive of severe encephalopathy. [acep.org]

• Prolonged QT Interval

  Ten patients received a benzodiazepine or an antipsychotic (or both) for sedation, three patients received an antiemetic, two patients received phenytoin as seizure prophylaxis, and one patient received magnesium for a prolonged QT interval corrected [mja.com.au]

Treatment with methylene blue is not effective in cases of low NADPH[11]. If treatment with methylene blue fails, the second line treatment is exchange transfusion[6]. [ejcrim.com]

However, intralipid may remain a treatment of last resort in centers lacking ECMO (for cardiogenic shock refractory to other interventions). [emcrit.org]

Data collected included patient's age, sex and State where the overdose took place, relevant medical history, details of bupropion ingestion (time of ingestion, dose, co-ingestants), clinical features, investigations, decontamination therapy and treatment [mja.com.au]

Many factors should be considered in the approach to evaluation, treatment, and prognostication of these patients. [e-jnc.org]

Treatment with activated charcoal should be considered for patients presenting within 60 minutes of ingestion in whom the risk of aspiration is low.10 Whole bowel irrigation may be considered for patients with large ingestions of sustained-release preparations [cmaj.ca]

Key Words: Bupropion; Coma; Overdose; Prognosis; Neurologic examination; Brain death INTRODUCTION Accurate neurological prognostication after brain injury can be exceedingly challenging. [e-jnc.org]

Evolving epidemiology of drug-induced seizures reported to a poison control center system. J Medical Toxicol. 2007;3:15–9. 11. Miller L, Griffith J. A comparison of bupropion, dextroamphetamine, and placebo in mixed-substance abusers. [acep.org]

In overdose it can cause seizures and cardiotoxicity however, good supportive care usually prevents any adverse outcome. Toxic Mechanism: Bupropion is a monocyclic antidepressant that suppresses nicotine cravings via an unknown mechanism. [litfl.com]

Levetiracetam is often used to prevent seizure recurrence (although no good evidence exists regarding this). [emcrit.org]