Cardiotoxicity Associated With Accidental Bupropion Ingestion in a Child

Givens, Melissa L.; Gabrysch, Jeremy

doi:10.1097/pec.0b013e31803f5a83

Cited by 17 publications

(9 citation statements)

References 16 publications

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“…Indeed, sinus tachycardia is the most common cardiovascular side effect associated with bupropion, mostly during overdosage [1–17]. Nonetheless, a number of bupropion‐related QTc interval prolongation have been reported [1,5,6,8–13,18].…”

Section: Introductionmentioning

confidence: 99%

QRS widening and QT prolongation under bupropion: a unique cardiac electrophysiological profile

Caillier

Pilote

Castonguay

et al. 2011

Fundamemntal Clinical Pharma

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QRS widening and QT prolongation are associated with bupropion. The objectives were to elucidate its cardiac electrophysiological properties. Patch-clamp technique was used to assess the I(Kr) -, I(Ks) -, and I(Na) -blocking effects of bupropion. Langendorff retroperfusion technique on isolated guinea-pig hearts was used to evaluate the MAPD(90) -, MAP amplitude-, phase 0 dV/dt-, and ECG-modulating effects of bupropion and of two gap junction intercellular communication inhibitors: glycyrrhetinic acid and heptanol. To evaluate their effects on cardiac intercellular communication, fluorescence recovery after photobleaching (FRAP) technique was used. Bupropion is an I(Kr) blocker. IC(50) was estimated at 34 μm. In contrast, bupropion had hardly any effect on I(Ks) and I(Na) . Bupropion had no significant MAPD(90) -modulating effect. However, as glycyrrhetinic acid and heptanol, bupropion caused important reductions in MAP amplitude and phase 0 dV/dt. A modest but significant QRS-widening effect of bupropion was also observed. FRAP experiments confirmed that bupropion inhibits gap junctional intercellular communication. QT prolongation during bupropion overdosage is due to its I(Kr) -blocking effect. QRS widening with bupropion is not related to cardiac sodium channel block. Bupropion rather mimics the QRS-widening, MAP amplitude- and phase 0 dV/dt -reducing effect of glycyrrhetinic acid and heptanol. Unlike class I anti-arrhythmics, bupropion causes cardiac conduction disturbances by reducing cardiac intercellular coupling.

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Section: Introductionmentioning

confidence: 99%

QRS widening and QT prolongation under bupropion: a unique cardiac electrophysiological profile

Caillier

Pilote

Castonguay

et al. 2011

Fundamemntal Clinical Pharma

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“…For example, Ayers and Tobias describe an adolescent with tachycardia, slurred speech, dry skin, ataxia, and seizures but no hyperreflexia following intentional ingestion of 15 to 30 100-mg tablets of bupropion [19]. Givens and Gabrysch reported an ingestion of 2 g of bupropion by a 3-year-old child that resulted in seizures and profound hemodynamic instability in conjunction with complications from whole bowel irrigation [20]. Finally, Spiller and Schaeffer report seizures, hallucinations, ataxia, mydriasis, and moist mucous membranes in a 7-year-old boy following ingestion of 1,050 mg of bupropion [21].…”

Section: Discussionmentioning

confidence: 96%

Bupropion Induced Serotonin Syndrome: A Case Report

Thorpe¹,

Pizon²,

Lynch³

et al. 2010

J. Med. Toxicol.

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Although there are no documented cases of serotonin syndrome (SS) following bupropion ingestion alone in the literature, the ability of bupropion to potentiate serotonin levels and lead to SS is known. A 15-year-old boy was found at home hallucinating. He then developed tonic-clonic activity. Upon arrival in the emergency department, he was confused and restless. On exam, he had tachycardia, hypertension, dilated pupils and dry oral mucosa, normal tone and reflexes in his arms, but rigidity and +4 reflexes in his legs with sustained clonus at his ankles. He was admitted and treated with intravenous fluids and lorazepam for his agitation. A urine drug screen (via gas chromatography/mass spectrometry) was positive only for naproxen and bupropion. Serum bupropion and hydroxybupropion levels drawn 17 h after his reported ingestion were 280 (therapeutic range 50-100) and 3,100 ng/mL (therapeutic range <485), respectively. Within 24 h of his admission, the patient was awake with normal vital signs and neurologic exam. To our knowledge, there are only three reported cases demonstrating SS in conjunction with bupropion toxicity; however, none of these were secondary to bupropion alone.

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“…Interpretation of some of the literature is limited due to patients either refusing to drink the PEG solution or WBI not recorded as being completed. While efficacy of WBI is difficult to interpret, no adverse events were reported in these studies; however, aspiration has been reported with WBI [247,248]. In body packers, WBI should be initiated in order to remove the packets as soon as possible, given the lifethreatening risk associated with even a single packet leaking.…”

Section: Gastrointestinal Decontaminationmentioning

confidence: 89%

Therapeutic Approach to the Critically Poisoned Patient

Schwarz¹

2016

Critical Care Toxicology

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Cardiotoxicity Associated With Accidental Bupropion Ingestion in a Child

Cited by 17 publications

References 16 publications

QRS widening and QT prolongation under bupropion: a unique cardiac electrophysiological profile

QRS widening and QT prolongation under bupropion: a unique cardiac electrophysiological profile

Bupropion Induced Serotonin Syndrome: A Case Report

Therapeutic Approach to the Critically Poisoned Patient

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