Abstract Bupropion is a dopamine, norepinephrine, and serotonin reuptake inhibitor that is being prescribed more frequently as an antidepressant. It is also often used for a variety of other clinical indications. Limited information is available about the varied presentation of bupropion overdose, with few cases reported highlighting these presentations. There have recently been a rising number of calls to poison centers involving bupropion overdose in adolescents and young adults. This trend was acutely seen in October 2017 when three adolescents presented to a tertiary care University Children’s Hospital in suburban New York following overdoses in attempted suicide. All three cases of bupropion overdose reviewed resulted in generalized tonic-clonic seizures and required intubation for at least three days, with one patient intubated for seven days. They experienced varying degrees of other symptoms including severe cardiotoxicity with vast prolongation of QTc, hallucinations, persistent tachycardia and tachypnea, loss of gag reflex, aspiration pneumonia, and agitation. One patient experienced significant neurologic findings mimicking the presentation of brain death, including absent doll’s eye and corneal responses, fixed and dilated pupils, flaccid limbs with areflexia, and burst suppression pattern on EEG. These cases provided an opportunity to bolster the body of literature of varied clinical presentations of bupropion overdose.
Keywords: bupropion; depression; dopamine; suicide; overdose; norepinephrine