New-generation antidepressants used in the treatment of depression are generally well tolerated. However, almost all antidepressants have the potential to lead to seizure 8. Compared with previous years, while the number of seizures related to tricyclic antidepressants, cocaine, and theophylline has declined, the cases of seizures caused by new drugs containing tramadol, venlafaxine, and especially bupropion have increased 9.
Our patients were admitted to hospitals just after drug intake but generalised seizures occurred after 12 hours. Active metabolites of bupropion result from intensive liver metabolism of R,R -hydroxybupropion, S,S -hydroxybupropion, threo-hydrobupropion and erythro-hydrobupropion. The mechanism of action is thought to depend on weak noradrenalin and dopamine reuptake inhibition Bupropion has sudden, continuous, and prolonged cyclothymic forms.
In sudden and continuous cyclothymic forms, peak plasma levels are seen within about 2 and 3 hours, respectively 1.
After an overdose of bupropion, clinical effects are primarily on the neurological, cardiovascular and gastrointestinal systems. Neurological effects can include tremor, confusion, agitation, hallucination, coma, and seizures. Cardiovascular effects involve tachycardia and conduction defects. QRS and QT prolongation can be seen. Gastrointestinal effects include trichinosis and vomiting. Mortalities have been reported but are not common 3 , Seizures can emerge both with treatment doses and an overdose of bupropion.
They can be caused by all forms of bupropion available on the market. In therapeutic use of the SR form, the risk of seizure is about 0. It has been reported that the incidence of seizures caused by overdose intake makes up a third of the cases with the IR form A study has suggested that there is a close relationship between seizures and dose. Those who take more than 30 tablets are more prone to seizures and almost every patient who takes more than 60 tablets has seizures In electrocardiograms of our cases, no dysrhythmia or conductive defects were detected.
For most of our patients who suffered from seizures, benzodiazepine was used as a treatment regime. The main pillar of treatment in case of bupropion overdose is supportive care. If patients come to the hospital just after the drug is taken, active carbon can be given. In our cases, supportive care was started right after admission and the patients were only given benzodiazepine during seizure.
We did not measure serum bupropion concentration in our patients. Our patients suffered from seizures after each had taken 4. Our case study suggests that there is a relationship between dose and seizures. It has been established that patients who take more than 15 tablets are more vulnerable to seizures.
Consistent with this, both of our patients experienced seizures. In conclusion, Bupropion, a drug launched to treat depression and smoking cessation, can cause seizures in patients who do not previous history of convulsion. Our study emphasises the importance of determining the potential risk of a drug for suicidal poisoning before it is presented to the market.
Therefore, clinicians should consider that bupropion may have convulsive effects even at lower doses. Written informed consent was obtained from patients. No conflict of interest was declared by the authors. No financial disclosure was declared by the authors. Multiple seizures after bupropion overdose in a small child. Neurochemical and psychotropic effects of bupropion in healthy male subjects. Cardiotoxicity associated with intentional ziprasidone and bupropion overdose.
J Toxicol Clin Toxicol. Pesola GR, Avarsarala J. Bupropion seizure proportion among new-onset generalized seizures and drug related seizures presenting to an emergency department. Status epilepticus at an urban public hospital in the s. Seizures associated with recreational drug abuse.
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