Activated Charcoal in Bupropion Overdose
Administer activated charcoal at a dose of 1-2 g/kg (50g standard adult dose) as soon as possible after bupropion overdose, provided the airway is intact or secured, recognizing that bupropion requires higher charcoal-to-drug ratios than many other medications for adequate adsorption. 1, 2
Critical Timing and Airway Considerations
- Activated charcoal should be given only when the patient has an intact airway or a secured airway, as this is the most critical contraindication to administration 1
- Administer as soon as possible after ingestion, ideally within 2-4 hours, though earlier is always better 1
- Always prioritize airway protection and hemodynamic stabilization before considering gastrointestinal decontamination 1
Bupropion-Specific Adsorption Characteristics
- Bupropion demonstrates pH-dependent adsorption to activated charcoal, with significantly better binding in simulated intestinal fluid (pH 6.8) compared to gastric fluid (pH 1.2) 2
- At a standard 10:1 activated charcoal-to-drug ratio, bupropion achieved ≥95% adsorption in intestinal fluid, but failed to reach this threshold even at 12:1 ratio in gastric fluid 2
- A single 50g dose of activated charcoal may be inadequate for clinically significant bupropion overdoses, particularly with immediate-release formulations where gastric adsorption is important 2
Dosing Strategy
- Standard dose: 1-2 g/kg body weight orally or via nasogastric tube (50g for adults) 1, 3
- For significant bupropion overdoses, consider higher initial doses or multiple-dose activated charcoal given the drug's lower binding efficiency in gastric pH and potential for large ingestions to saturate charcoal's adsorption capacity 2, 4
- Multiple-dose activated charcoal (20-50g every 4-6 hours) may enhance elimination even after systemic absorption, though this should only be administered under medical supervision 1, 5
Formulation Selection
- Use non-sorbitol-containing products in children under 1 year old, as sorbitol formulations have caused fatal hypernatremic dehydration 1
- In older children and adults, sorbitol-containing formulations can be used cautiously for single doses 3, 6
Common Pitfalls to Avoid
- Do not delay charcoal administration waiting for gastric emptying procedures—activated charcoal is generally more effective than gastric lavage 4
- Do not administer if the patient has impaired consciousness without airway protection, as aspiration risk outweighs benefits 1
- Do not assume a standard 50g dose is sufficient for massive bupropion ingestions; the adsorption capacity can be saturated with very large overdoses 2, 4
- Contact poison control centers for guidance, especially when dealing with mixed ingestions or uncertainty about timing 1, 3