Bupropion-induced tinnitus after dose escalation: a rare and reversible adverse effect - a case report

Bupropion is a norepinephrine-dopamine reuptake inhibitor commonly prescribed for major depressive disorder and smoking cessation. It is preferred for its minimal serotonergic activity and favorable side effect profile. However, rare adverse events such as tinnitus - the perception of sound without an external source - have been occasionally reported.

We report a 45-year-old male treated for depression with bupropion 150 mg/day, who developed bilateral low-pitched humming tinnitus after the dose was increased to 300 mg/day. He had no history of ear disease, noise trauma, or ototoxic medication use. Physical examination, audiometry, and brain MRI were unremarkable. Following dose reduction, the tinnitus partially improved, and it completely resolved after stopping the drug.

The temporal correlation between dose escalation and tinnitus onset, along with symptom resolution after drug cessation and lack of alternative causes, suggests a probable adverse drug reaction. The exact mechanism remains uncertain but may involve altered dopaminergic or noradrenergic signaling within the auditory system. Only a few cases of bupropion-induced tinnitus have been documented, making this report a relevant addition to the limited literature.

This case underscores the rarity, bilateral nature, and reversibility of bupropion-induced tinnitus. It highlights the importance of clinician vigilance, structured patient education during dose escalation, and timely intervention to prevent unnecessary morbidity. As this is a single case report, broader clinical studies are warranted to substantiate causality and incidence. This case underscores the importance of clinician awareness regarding bupropion-induced tinnitus, particularly at higher doses. The rarity and reversibility highlight the need for vigilance, patient education during dose escalation, and timely dose adjustment or discontinuation. Limitations include the single-case design and possible confounders such as comorbid anxiety.