Bupropion toxicity

Revision as of 18:18, 13 January 2021 by Elcatracho (talk | contribs) (→‎Background)
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)


  • Bupropion is a norepinephrine/dopamine reuptake inhibitor used for depression, ADHD, and smoking cessation
  • Structurally part of the synthetic cathinones
  • Toxicity occurs with ingestion of >450mg/d

Clinical Features

Differential Diagnosis




  • Activated charcoal or gastric emptying are not indicated
    • Consider whole-bowel irrigation for sustained-release formulations
  • Seizure Treatment
  • Early vasopressor and ionotropic agents for hemodynamic instability (Bupropion depresses myocardial contractility)
  • Sodium bicarbonate if QRS prolongation
    • May be unresponsive to bicarb[2]as mechanism of QRS prolongation thought thought to be secondary to inhibition of gap junctions[3]
  • Intralipid[4] or ECMO for refractory cases


  • Consider discharge if asymptomatic after 8hr for regular-release ingestions

See Also

External Links


  1. Giroski, L., & Shih, R. (2012). QTC Prolongation and Torsades in Bupropion Overdoses Presenting to United States Emergency Departments. The Journal of Emergency Medicine, 43(5), 934–935. doi:10.1016/j.jemermed.2012.09.104
  2. Wills BK, Zell-Kanter M, Aks SE. Bupropion-associated QRS prolongation unresponsive to sodium bicarbonate therapy. Am J Ther. 2009;16(2):193-196. doi:10.1097/MJT.0b013e3180a5bd83
  3. Caillier B, Pilote S, Castonguay A, et al. QRS widening and QT prolongation under bupropion: a unique cardiac electrophysiological profile. Fundam Clin Pharmacol. 2012;26(5):599-608. doi:10.1111/j.1472-8206.2011.00953.x
  4. Sirianni AJ, Osterhoudt KC, Calello DP, et al. Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine. Ann Emerg Med. 2008;51(4):412-415.e1. doi:10.1016/j.annemergmed.2007.06.004