Two Cases of Serotonin Syndrome After Bupropion Overdose Treated With Cyproheptadine

Murray, Brian; Carpenter, Joseph; Sayers, Joshua; Yeh, Michael; Beau, Jordan; Kiernan, Emily; Wolf, Matthew J.; Bolton, Tonya A.; Kazzi, Ziad

doi:10.1016/j.jemermed.2020.10.039

Cited by 5 publications

(4 citation statements)

References 33 publications

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“…Serotonin syndrome has been implicated in bupropion overdoses, albeit often involving a concomitant SSRI, SNRI, monoamine oxidase inhibitor (MAO-I), or tricyclic antidepressant (TCA) [ 5 ]. Toxicity from isolated bupropion overdoses has been identified in the case of a 14-year-old male and a 19-year-old female and a retrospective study which identified six cases of serotonin toxicity with a median dose of 2,250 mg [ 12 , 13 ]. Unfortunately, the dose in this case is unknown, and bupropion serum concentration levels were unable to be processed.…”

Section: Discussionmentioning

confidence: 99%

Delayed Serotonin Syndrome and Non-cardiogenic Pulmonary Edema Following Bupropion Overdose in a Seven-Year-Old Female: A Case Report and Review of Literature

Craft,

Burdsall,

Sahhar

2024

Cureus

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Bupropion is an atypical antidepressant prescribed for depression and attention-deficit/hyperactivity disorder and to aid in smoking cessation. Bupropion overdose management is largely aimed toward common sequelae, including seizures, tachycardia, and QTc prolongation. In this case report, we identify a rare event of pediatric bupropion overdose with aforementioned common sequela and atypical features, including a delayed presentation of serotonin syndrome and non-cardiogenic pulmonary edema. This case follows a seven-year-old Caucasian female with autism spectrum disorder (ASD) who presented in status epilepticus following an accidental bupropion overdose and required multiple anti-seizure medications, endotracheal intubation, and admission to the pediatric intensive care unit (PICU). The patient's condition improved, and she was extubated 25 hours after admission and transitioned to high-flow nasal cannula therapy. On day 3 of admission, she became febrile and developed dyspnea with decreased breath sounds and intercostal retractions, tachycardia, a rigid abdomen and extremities with sporadic tremors, pulmonary edema, and a prolonged QTc interval. Targeted therapies were initiated, and following treatment, our patient showed remarkable improvement in the subsequent 24 hours and was discharged home five days after the initial presentation. This case identifies a delayed presentation of uncommon and serious complications of bupropion overdose, including pulmonary edema and serotonin syndrome, in a pediatric patient. Prompt investigation and identification of bupropion toxicity can help practitioners mitigate further complications during admission and reduce morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Delayed Serotonin Syndrome and Non-cardiogenic Pulmonary Edema Following Bupropion Overdose in a Seven-Year-Old Female: A Case Report and Review of Literature

Craft,

Burdsall,

Sahhar

2024

Cureus

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“… 20 Given that the patient had been on the same dose of duloxetine since injury with the same dose of bupropion for over 6 weeks prior to the onset of any symptoms related to SS, this interaction is unlikely to have been a primary direct cause of SS. The case reports of bupropion-associated SS are primarily related to bupropion overdose or a combination of bupropion with other serotonergic agents, 21 , 22 , 23 , 24 , 25 and cases of SS involving bupropion have predominantly been reported acutely after a medication change/adjustment, 22 with only 1 study demonstrating SS occurring after 3 weeks. 23 The possibility that the duloxetine/bupropion combination solely contributed to SS in this patient cannot be completely ruled out; however, given a case series of 14 individuals who developed SS at a mean of 6 weeks post medication changes, though none of which involved bupropion or duloxetine.…”

Section: Discussionmentioning

confidence: 99%

Serotonin Syndrome Precipitated by Amantadine in a Patient With Persistent Post Concussive Symptoms – A Case Report

Esterov,

Schultz,

Bottemiller

et al. 2023

Archives of Rehabilitation Research and Clinical Translation

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“…Serotonin syndrome [23,24] 5HT2A antagonistic actions have been used as an antidote for cases with serotonin syndrome.…”

Section: Evidence Based On Recent Studiesmentioning

confidence: 99%

“…Therefore, it is imperative to make inquiries into these complex relationships, risks, and benefits of off-label cyproheptadine use in children and adolescents with cooccurring mental health conditions. Cyproheptadine has an affinity for a wide range of receptors [14][15][16][17][18][19][20][21][22] and many proposed mechanisms of action to support its off-label use [23][24][25][26][27][28].…”

Section: Introductionmentioning

confidence: 99%

Off-Label Cyproheptadine in Children and Adolescents: Psychiatric Comorbidities, Interacting Variables, Safety, and Risks of Hepatotoxicity

Gupta¹,

Gupta²,

Madabushi³

2023

Cureus

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Cyproheptadine is a widely prescribed first-generation antihistamine, and due to its unique chemical structure, it has a popular off-label choice for a range of clinical conditions. Its efficacy is widely debated in the literature, but there are reports of hepatotoxicity as a rare adverse effect. Its benefits in migraine prophylaxis and appetite stimulation also underscore a highly overlapping clinical pathway that requires additional assessment and evaluation. The evidence suggests a baseline metabolic profile before initiation and assessment for co-occurring mental health conditions may improve overall response with evidencebased mental health interventions.

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Two Cases of Serotonin Syndrome After Bupropion Overdose Treated With Cyproheptadine

Cited by 5 publications

References 33 publications

Delayed Serotonin Syndrome and Non-cardiogenic Pulmonary Edema Following Bupropion Overdose in a Seven-Year-Old Female: A Case Report and Review of Literature

Delayed Serotonin Syndrome and Non-cardiogenic Pulmonary Edema Following Bupropion Overdose in a Seven-Year-Old Female: A Case Report and Review of Literature

Serotonin Syndrome Precipitated by Amantadine in a Patient With Persistent Post Concussive Symptoms – A Case Report

Off-Label Cyproheptadine in Children and Adolescents: Psychiatric Comorbidities, Interacting Variables, Safety, and Risks of Hepatotoxicity

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