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. Although most patients recovered without sequelae, deaths associated with overdoses of bupropion alone have been reported in patients ingesting large doses of the drug Multiple uncontrolled seizures, bradycardia, cardiac failure, and cardiac arrest prior to death were reported in these patients. 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.
Important considerations in bupropion overdose management include:
- Consulting a Certified Poison Control Center for up-to-date guidance and advice 1
- Providing supportive care, including close medical supervision and monitoring
- Considering the possibility of multiple drug overdose
- Being aware of potential serious reactions, such as seizures, hallucinations, loss of consciousness, and cardiac complications
- Recognizing that there are no known antidotes for bupropion 1
From the Research
Bupropion overdose management requires immediate medical attention with a focus on seizure prevention and cardiac monitoring, as highlighted in a recent study 2 that emphasizes the importance of prompt intervention to prevent serious neurological and cardiovascular adverse effects. The management of bupropion overdose involves several key components, including:
- Administration of activated charcoal if the patient presents within 1-2 hours of ingestion
- Prompt use of benzodiazepines, such as lorazepam 2-4 mg IV or diazepam 5-10 mg IV, for seizure control or prevention, as seizures are a common complication occurring in up to 15% of significant overdoses 3
- Continuous cardiac monitoring due to the risk of QRS prolongation and arrhythmias; sodium bicarbonate (1-2 mEq/kg IV) may be needed if QRS widening occurs
- Supportive care including IV fluids, correction of electrolyte abnormalities, and maintenance of adequate oxygenation
- Monitoring for at least 24 hours due to bupropion's extended-release formulations, which can cause delayed toxicity The mechanism of toxicity involves dopamine and norepinephrine reuptake inhibition and nicotinic acetylcholine receptor antagonism, which explains the neurological and cardiovascular effects, as discussed in a study published in 2022 4. It is essential to note that hemodialysis is generally not effective due to bupropion's high protein binding and large volume of distribution. In terms of specific patient populations, a study from 2015 5 highlights the risk of bupropion overdose in children, emphasizing the need for careful storage and handling of the medication to prevent accidental ingestion. Overall, the management of bupropion overdose requires a comprehensive approach that prioritizes seizure prevention, cardiac monitoring, and supportive care, as emphasized in the most recent study from 2023 2.