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Mini Episode: Who Seizes in Bupropion Overdose with Dr Ari Filip MD
- Seizure Risk: Patients can seize 8–24 hours post-ingestion. Neurologic symptoms and tachycardia often precede seizures.
- Delayed Symptoms: Co-ingestions may mask tachycardia, and symptoms can be significantly delayed.
- Key Management Advice:
- Do not discharge patients without consulting a toxicologist or poison center about observation times.
- Do not dismiss tachycardia and anxiety as situational in cases of bupropion overdose.
Key Studies
- Spiller 1994: Review of instant-release bupropion overdoses.
- Shepherd 2004: Seizures predominantly occur with sustained-release products. Most cases had prodromal neuropsychiatric symptoms.
- Starr 2009: Analysis of XL products:
- Symptoms predicting seizures: Tachycardia, tremor, and agitation.
- Tachycardia may be masked by coingestions and symptoms may be very delayed
- Seizures occurred as late as 24 hours, with 25% occurring after 8 hours.
- Offerman 2020: Study of sustained/extended-release products:
- Tachycardia (duration and rate >120 bpm) predicts seizures.
- Hypotension and neuropsychiatric symptoms also predictive.
- Prehospital seizures associated with cardiac arrest—indicative of poor outcomes.
- Rianprakaisang 2021: ToxIC database review of seizure risk factors:
- QTc prolongation and HR >140 bpm are predictive of seizures.
