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Bupropion Toxicity - #PHARMFAX

Wellbutrin was withdrawn from the market in 1986 due to high rates of seizures in a study on nondepressed bulimic patients.

 


Wellbutrin was withdrawn from the market in 1986 due to high rates of seizures in a study on nondepressed bulimic patients. It was reintroduced back into the market shortly after the manufacter completed a study showing doses between 300 - 450 mg had a similiar seizure incidence as other antidepressants.


Doses above and even at therapeutic regimens can have neurotoxicities; thats a narrow window considering other seizure causing meds, CYP interactions, and roughly ~21 hr duration with XL formulations. Benzodiazepines for all initial seizure presentations. If progressing to refractory status epilepticus, I'd avoid cardiotoxic secondary agents like fosphenytoin.


QRS widening and QTc prolongation are always on the radar. Consider sodium bicarbonate and magnesium sulfate for the respective indications, I wouldn't count on it since we only presume the cardiac effects are via gap junctions.


Solid supportive care is the foundation for all drug poisonings. Vasopressors and RSI agents for patients in shock. Intralipid emulsion has shown in case reports to be effective after standard ACLS measures. Did you share the #pharmfax? Check out website at https://zurl.co/Dtjx and I hope you learned something new.


Recommended Read/Watch


ESETT Secondary AED Overview - https://www.instagram.com/p/CpOgF9kJpwM/


ESETT Secondary AED Safety - https://www.instagram.com/reel/CpQoQfivLvT/



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