Serotonin toxicity from isolated bupropion overdoses

Area of Science:

• Toxicology
• Pharmacology
• Emergency Medicine

Background:

• Bupropion, a norepinephrine and dopamine reuptake inhibitor, may also activate serotonin receptors at high doses.
• Previous studies may underestimate bupropion's role in serotonin toxicity due to co-ingestions.
• Isolated bupropion overdoses can lead to severe serotonin toxicity.

Purpose of the Study:

• To determine the incidence of serotonin toxicity in patients with isolated bupropion overdoses.
• To identify risk factors associated with bupropion-induced serotonin toxicity.

Main Methods:

• Retrospective analysis of patients with bupropion toxicity from 2015-2017.
• Exclusion of patients who ingested other serotonergic medications.
• Retrospective diagnosis of serotonin toxicity using Hunter Criteria.

Main Results:

• 18 patients ingested bupropion without other serotonergic drugs.
• 33% incidence of serotonin toxicity in this isolated bupropion overdose group.
• Higher likelihood of serotonin toxicity in suicide attempts compared to accidental or recreational ingestions.
• Median bupropion dose was 2,250 mg in patients with serotonin syndrome.

Conclusions:

• The incidence of bupropion-induced serotonin toxicity is higher than previously reported.
• Clinicians must actively monitor for serotonergic toxicity in bupropion overdose cases.
• Bupropion overdose, especially in suicide attempts, poses a significant risk for serotonin toxicity.