Successful management of bupropion poisoning: possible benefit of acidosis treatment

Abstract

Bupropion is used as an antidepressant and smoking cessation aid. It has been described in the literature as a norepinephrine - dopamine reuptake inhibitor and is also a nicotinic antagonist. Bupropion itself is not a common cause of intoxication cases seen in Emergency Department (ED). The most important side effect is an increase in risk for epileptic seizures. We aimed to present the management of a 29-year-old female patient in ED with epileptic seizures and acidosis due to bupropion intoxication,who had taken 30 bupropion 150 mg tablets and 16 fluoksetin 20 mg tablets for suicidal purpose. According to her blood gas counts sodium bicarbonate therapy was begun in ED and after having response to the treatment was continued in intensive care unit. She was discharged three days later without any other seizures and complications. Although bupropion intoxication is rare it can cause severe metabolic acidosis and epileptic seizures. There is no specific antidote therapy to bupropion so symptomatic therapy still have benefit.

Keywords

• Bupropion intoxication,fluoxetine intoxication,seizure,acidosis

References

1. [1] Stall N, Godwin J, Juurlink D. Bupropion abuse and overdose. CMAJ 2014;186:1015.
2. [2] Thorpe EL, Pizon AF, Lynch MJ, Boyer J. Bupropion induced serotonin syndrome: a case report. J Med Toxicol 2010;6:168-71.
3. [3] Mercerolle M, Denooz R, Lachatre G, Charlier C. A fatal case of bupropion (Zyban) overdose. J Anal Toxicol 2008;32:192-6.
4. [4] Boora K, Cummings MR, Marshall DR. Generalized seizure in three adolescents with bupropion overdose. J Child Adolesc Psychopharmacol 2010;20:159-60.
5. [5] Storrow AB. Bupropion overdose and seizure. Am J Emerg Med 1994;12:183-4.
6. [6] Bucklin MH, Gorodetsky RM, Wiegand TJ. Prolonged lipemia and pancreatitis due to extended infusion of lipid emulsion in bupropion overdose. Clin Toxicol (Phila) 2013;51:896-8.
7. [7] Silverstone PH, Williams R, McMahon L, Fleming R, Fogarty S. Convulsive liability of bupropion hydrochloride metabolites in Swiss albino mice. Ann Gen Psychiatry 2008;7:19.
8. [8] Benarroch EE. GABAA receptor heterogeneity, function, and implications for epilepsy. Neurology 2007;68:612-4.

9. [9] Dunwiddie TV, Masino SA. The role and regulation of adenosine in the central nervous system. Annu Rev Neurosci 2001;24:31-55.
10. [10] Chesler M, Kaila K. Modulation of pH by neuronal activity. Trends Neurosci 1992;15:396-402.
11. [11] Levraut J, Garcia P, Giunti C, Ichai C, Bouregba M, Ciebiera JP, et al. The increase in CO2 production induced by NaHCO3 depends on blood albumin and hemoglobin concentrations. Intensive Care Med 2000;26:558-64.
12. [12] Wilson B, Paul P, Mehta S, Coffey BJ. Hypokalemia secondary to bupropion sustained release overdose. J Child Adolesc Psychopharmacol 2013;23:57-60.
13. [13] Spiller HA, Bottei E, Kalin L. Fatal bupropion overdose with post mortem blood concentrations. Forensic Sci Med Pathol 2008;4:47-50.
14. [14] Cardamone L, Salzberg M, O’Brien T, Jones N. Antidepressant therapy in epilepsy: can treating the comorbidities affect the underlying disorder? Br J Pharmacol 2013;168:1531-54.
15. [15] Henshall DC, Dürmüller N, White HS, Williams R, Moser P, Dunleavy M, et al. Electroencephalographic and behavioral convulsant effects of hydrobromide and hydrochloride salts of bupropion in conscious rodents. Neuropsychiatr Dis Treat 2009;5:189-206.
16. [16] Noe KH, Manno EM. Mechanisms underlying status epilepticus. Drugs Today (Barc) 2005;41:257-66.
17. [17] Silverstone PH, Williams R, McMahon L, Fleming R, Fogarty S. Effect of increasing intraperitoneal infusion rates on bupropion hydrochloride-induced seizures in mice. Ann Gen Psychiatry 2008;7:27.