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 evidenced by a recent study published in 2023 2. The management of bupropion overdose is crucial to prevent morbidity and mortality. Key aspects of management include:
- Immediate transportation to an emergency department
- Administration of activated charcoal if ingestion was recent (within 1-2 hours)
- Continuous cardiac monitoring to detect potential arrhythmias, such as tachycardia and hypertension
- Treatment of seizures with benzodiazepines, such as lorazepam 2-4 mg IV or diazepam 5-10 mg IV, as seizures are a common complication of bupropion overdose, occurring in approximately 27.9% of patients 3
- Consideration of sodium bicarbonate (1-2 mEq/kg IV) for QRS prolongation, a potential complication of bupropion overdose
- Management of hypotension with IV fluids and vasopressors if needed
- Prolonged observation due to the potential for delayed toxicity, particularly with extended-release formulations, which can cause toxicity up to 24 hours post-ingestion 4 The unique toxicity profile of bupropion, which inhibits norepinephrine and dopamine reuptake while also blocking nicotinic acetylcholine receptors, necessitates a comprehensive approach to management, as highlighted in a study published in 2022 4. Some important considerations in bupropion overdose management include:
- The risk of seizures is associated with antecedent tachycardia or altered mental status, as reported in a study published in 2020 3
- The potential for status epilepticus, particularly in pediatric patients, as highlighted in a case report published in 2015 5
- The importance of keeping bupropion out of reach of children to prevent accidental overdose, as emphasized in a case report published in 2015 5
- The need for high-resource utilization in the management of bupropion overdose, as reported in a study published in 2022 4