Diferencia entre revisiones de «Bupropion toxicity»

(Created page with "==Background== *Inhibits reuptake of norepinephrine and dopamine *Toxicity occurs with ingestion of >450mg/d ==Clinical Features== #Agitation #Dizziness #Tremor #N/V #Drowsiness...")
 
 
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==Background==
==Background==
*Inhibits reuptake of norepinephrine and dopamine
*[[Bupropion]] is a norepinephrine/dopamine reuptake inhibitor used for depression, ADHD, and smoking cessation
*Structurally part of the [[Synthetic cathinone toxicity|synthetic cathinones]]
*Toxicity occurs with ingestion of >450mg/d
*Toxicity occurs with ingestion of >450mg/d


==Clinical Features==
==Clinical Features==
#Agitation
*[[Agitation]]
#Dizziness
*[[Dizziness]]
#Tremor
*Tremor
#N/V
*[[Nausea/vomiting]]
#Drowsiness
*Drowsiness/[[lethargy]]
#Tachycardia
*Tachycardia
#Seizure
*[[Seizure]]
##May develop in isolation from other symptoms
**May develop in isolation from other symptoms
##Develops within first 1-4hr for regular-release, up to 8hr for delayed release forms
**Develops within first 1-4hr for regular-release, up to 8hr for delayed release forms
*[[Hypotension]] and [[cardiogenic Shock]]


==Treatment==
==Differential Diagnosis==
#GI decontamination
{{Seizure DDX}}
##Consider whole-bowel irrigation for sustained-release formulations
 
#Seizure Treatment
==Evaluation==
##Benzos are 1st line
*CBC, CMP
##Barbs are 2nd line
*[[ECG]] to eval for QRS and [[QT prolongation]]
**Typically does not lead to Torsades de Pointes<ref>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 </ref>
 
==Management==
*Activated charcoal or gastric emptying are not indicated
**Consider whole-bowel irrigation for sustained-release formulations
*[[Seizure|Seizure Treatment]]
**[[Benzos]] are 1st line
**[[Barbiturates]] are 2nd line
*Early vasopressor and ionotropic agents for hemodynamic instability (Bupropion depresses myocardial contractility)
*[[Sodium bicarbonate]] if QRS prolongation
**May be unresponsive to bicarb<ref>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</ref>as mechanism of QRS prolongation thought thought to be secondary to inhibition of gap junctions<ref>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</ref>
*Intralipid<ref>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</ref> or ECMO for refractory cases


==Disposition==
==Disposition==
*Consider discharge if asymptomatic after 8hr for regular-release ingestions
*Consider discharge if asymptomatic after 8hr for regular-release ingestions


==Source==
==See Also==
*Tintinalli
*[[Bupropion]]
 
==External Links==
*https://emcrit.org/toxhound/illbutrin/
*https://emcrit.org/ibcc/bupropion/


[[Category:Tox]]
==References==
<references/>
[[Category:Toxicology]]

Revisión actual - 18:18 13 ene 2021

Background

  • 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

Seizure

Evaluation

Management

  • 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

Disposition

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

See Also

External Links

References

  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
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