From the Guidelines
Signs of high bupropion exposure include seizures, agitation, hallucinations, rapid heartbeat, severe headache, confusion, tremors, nausea, vomiting, and insomnia, with seizures being the most serious risk, occurring in about 0.4% of patients at standard doses but increasing significantly with higher doses 1.
Key Symptoms
- Seizures
- Agitation
- Hallucinations
- Rapid heartbeat
- Severe headache
- Confusion
- Tremors
- Nausea
- Vomiting
- Insomnia These symptoms are concerning and can be life-threatening, especially seizures, which are the most serious risk associated with high bupropion exposure 1.
Mechanism and Treatment
Bupropion affects multiple neurotransmitters, including dopamine and norepinephrine, and at high levels, can disrupt normal brain electrical activity and cardiovascular function 1. Treatment typically involves stopping the medication, supportive care, and sometimes activated charcoal if the ingestion was recent.
Important Considerations
The risk of adverse effects increases substantially at doses above 450mg daily, which is why this is the maximum recommended daily dose 1. Patients should be monitored closely for any mood changes, especially in individuals younger than 24 years, due to the potential increase in suicidal thoughts associated with bupropion 1.
From the FDA Drug Label
Overdoses of up to 30 grams or more of bupropion have been reported. Seizure was reported in approximately one third of all cases. Other serious reactions reported with overdoses of bupropion alone included hallucinations, loss of consciousness, mental status changes, sinus tachycardia, ECG changes such as conduction disturbances or arrhythmias, clonus, myoclonus, and hyperreflexia. Fever, muscle rigidity, rhabdomyolysis, hypotension, stupor, coma, and respiratory failure have been reported mainly when bupropion was part of multiple drug overdoses.
The signs of high bupropion exposure include:
- Seizure
- Hallucinations
- Loss of consciousness
- Mental status changes
- Sinus tachycardia
- ECG changes such as conduction disturbances or arrhythmias
- Clonus
- Myoclonus
- Hyperreflexia
- Fever
- Muscle rigidity
- Rhabdomyolysis
- Hypotension
- Stupor
- Coma
- Respiratory failure 2 2
From the Research
Signs of High Bupropion Exposure
The signs of high bupropion exposure can be severe and potentially life-threatening. Some of the common signs include:
- Seizures: reported in 11% of patients 3 and 47.1% of single bupropion overdoses 4
- Tachycardia: significant tachycardia, often greater than 140 bpm 4
- Agitation: a common effect, reported in 31.7% of single bupropion overdoses 4
- Hallucinations: reported in patients with bupropion overdose 3
- Sinus bradycardia: a less frequently reported effect, associated with massive bupropion overdose 5
- Hypotension: reported in a patient with massive bupropion overdose 5
- Toxic psychosis: reported in 20.4% of single bupropion overdoses 4
- Myoclonus/tremor/hyperreflexia: reported in 19% of single bupropion overdoses 4
- Serotonin toxicity: bupropion may be an atypical cause of serotonin toxicity, diagnosed in 5.9% of single bupropion overdoses 4
Cardiovascular Effects
High bupropion exposure can also lead to significant cardiovascular effects, including:
- Sinus tachycardia with prolonged QTc and QRS intervals 5
- Paradoxical cardiac effects at higher amounts of ingestion 5
- Hypertension: a primary toxic effect of bupropion 5
Neurological Effects
Neurological effects of high bupropion exposure can include: