From the Guidelines
The treatment for seizures induced by an overdose of bupropion (Wellbutrin) and citalopram (Celexa) involves immediate administration of benzodiazepines, typically intravenous lorazepam or diazepam, which are first-line agents for terminating active seizures. If seizures persist despite benzodiazepines, second-line treatments include levetiracetam, fosphenytoin, or valproate, as these have been shown to result in cessation of seizures in approximately half of all patients with benzodiazepine-resistant status epilepticus 1. Supportive care is crucial, including:
- Airway management
- Oxygen administration
- Cardiac monitoring Activated charcoal may be administered within 1-2 hours of ingestion to reduce drug absorption if the patient is alert and protecting their airway. Intravenous fluids help maintain blood pressure and enhance drug elimination. These medications work by enhancing inhibitory GABA neurotransmission to suppress the excessive neuronal activity causing seizures. The overdose of bupropion and citalopram can cause seizures through different mechanisms - bupropion lowers the seizure threshold by inhibiting dopamine reuptake, while citalopram's serotonergic effects can contribute to seizure activity, making prompt treatment essential 1. It is essential to note that the benefit of early treatment and cessation of status epilepticus is a reduction in morbidity and mortality, with limited harms apart from potential adverse drug reactions 1. In cases of refractory status epilepticus, valproate has been shown to be an effective and safe option, with potentially fewer adverse effects compared to phenytoin 1. Therefore, prompt administration of benzodiazepines followed by second-line treatments such as levetiracetam, fosphenytoin, or valproate, along with supportive care, is the recommended approach for managing seizures induced by an overdose of bupropion and citalopram.
From the FDA Drug Label
10 OVERDOSAGE
- 1 Human Overdose Experience 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. 10.2 Overdosage Management Consult a Certified Poison Control Center for up-to-date guidance and advice. Call 1-800-222-1222 or refer to www.poison.org. There are no known antidotes for bupropion. In case of an overdose, provide supportive care, including close medical supervision and monitoring. Consider the possibility of multiple drug overdose.
The treatment for seizures induced by an overdose of bupropion (Wellbutrin) and citalopram (Celexa) is supportive care, including:
- Close medical supervision
- Monitoring It is recommended to consult a Certified Poison Control Center for up-to-date guidance and advice by calling 1-800-222-1222 or referring to www.poison.org 2.
From the Research
Treatment for Seizures Induced by Overdose of Bupropion (Wellbutrin) and Citalopram (Celexa)
- The treatment for seizures induced by an overdose of bupropion (Wellbutrin) and citalopram (Celexa) involves several approaches:
- For citalopram overdose, sodium bicarbonate can be considered as a treatment modality in patients with EKG abnormalities of prolongation of QRS or QTc interval 3.
- Benzodiazepines are generally accepted as the first-line anticonvulsant therapy for drug-induced seizures, including those caused by bupropion and citalopram overdose 4.
- If benzodiazepines fail to halt seizures promptly, second-line drugs include barbiturates and propofol 4.
- Clonazepam has been shown to be effective in protecting against bupropion-induced convulsions in preclinical studies, with a broad therapeutic window and favorable protective index 5.
- Active carbon and neuro-intensive care treatment, including respiratory support, may be necessary in severe cases of bupropion overdose 6.
Management of Seizures and Other Complications
- Seizures induced by bupropion overdose can be severe and may require intensive care treatment, including respiratory support 7, 6.
- The clinical course of bupropion intoxication can include myoclonic seizures, generalized tonic-clonic seizures, coma, and EEG burst-suppression 6.
- Treatment of bupropion overdose should be individualized and may involve a combination of anticonvulsant drugs, supportive care, and monitoring for cardiovascular and neurological complications 7, 5, 6.
- Patients with an increased risk of cardiovascular issues and seizures should be evaluated before starting bupropion or increasing the dosage 7.