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Toxicology

Bupropion Toxicity

Bupropion toxicity is a potentially life-threatening condition requiring rapid recognition and coordinated management, particularly following overdose involving extended-release formulations that may cause delayed symptom onset and sudden clinical deterioration. Neurologic and cardiovascular complications can include agitation, tachycardia, conduction abnormalities, delayed-onset seizures, status epilepticus, and death. This course reviews the epidemiology, clinical presentation, risk stratifica

v1 · Reviewed Nov 7, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • Bupropion toxicity is a potentially life-threatening condition requiring rapid recognition and coordinated management
  • Neurologic and cardiovascular complications can include agitation, tachycardia, conduction abnormalities, delayed-onset seizures, status epilepticus, and death.
  • Severe toxicity may include status epilepticus, cardiac arrhythmias, cardiogenic shock, and death.
  • Identify early clinical features of bupropion toxicity, including seizures, tachyarrhythmias, altered mental status, and QRS or QT abnormalities.
  • Severe toxicity may progress to status epilepticus, malignant dysrhythmias, cardiogenic shock, or central nervous system depression requiring intubation.
  • initiate continuous cardiac monitoring with frequent assessment of vital signs.
  • A 12-lead electrocardiogram (ECG) is necessary to evaluate for conduction abnormalities, including QRS or QT prolongation.
  • obtain serum acetaminophen and salicylate concentrations given the frequency of coingestions
  • a point-of-care glucose in patients with seizures or altered mental status.
  • a serum pregnancy test in patients who can get pregnant who are of childbearing age
  • electrolytes, to help identify electrolyte abnormalities that can perpetuate cardiac conduction abnormalities.
  • bedside electroencephalogram monitoring to evaluate for continued seizure activity.
  • Early stabilization with airway, breathing, and circulation assessment, continuous cardiac monitoring, and prompt treatment of seizures with benzodiazepines are essential.
  • Clinicians treat seizures promptly with benzodiazepines as first-line therapy.
  • Clinicians treat life-threatening arrhythmias in accordance with Advanced Cardiac Life Support guidelines, with adjuncts as indicated by the clinical scenario.
  • Vasopressors treat cardiogenic shock.
  • Because bupropion lowers the seizure threshold, its use in patients with preexisting seizure risk factors, such as a history of seizure disorder, an eating disorder, or those undergoing ethanol or central nervous system (CNS) depressant withdrawal, creates an unacceptably high risk of seizures, even at standard doses, making these conditions contraindications.
  • Barbiturates, such as phenobarbital, are appropriate second-line agents for refractory seizures.
  • Patients with seizures refractory to treatment with benzodiazepines and barbiturates may require sedation and intubation with bedside electroencephalogram monitoring to evaluate for continued seizure activity.
  • Toxicology experts support intravenous lipid emulsion (ILE) for severe, life-threatening toxicity, including refractory status epilepticus or hemodynamic instability; however, clinicians generally reserve it for rescue therapy.
  • Veno-arterial extracorporeal membrane oxygenation is a potential treatment option for refractory cardiogenic shock or cardiac arrest.
  • Phenytoin is not effective as it does not effectively treat toxin-induced seizures and fails to address the underlying mechanism.
  • bupropion-induced QRS prolongation may not respond to sodium bicarbonate because the cardiotoxicity appears related to impaired myocardial gap junction communication rather than sodium channel inhibition.
  • continuous cardiac monitoring
  • extended observation, including cardiac monitoring, is often warranted.
  • Patients with seizures, hemodynamic instability, life-threatening arrhythmias, or severe delirium require intensive care monitoring.
  • Because delayed seizures can occur, particularly with sustained-release and extended-release formulations, patients with these ingestions should undergo observation for at least 24 hours.
  • Patients should remain asymptomatic and have stable vital signs before medical clearance for discharge or psychiatric evaluation.
  • Cardiogenic shock
  • Cardiac arrest
  • Death
  • Delirium and hallucinations
  • Lactic acidosis
  • Life-threatening dysrhythmias
  • QRS widening and QT prolongation
  • Respiratory failure
  • Rhabdomyolysis from sustained muscle activity
  • Seizures, including status epilepticus and delayed-onset seizures
  • Severe altered mental status with loss of airway protection
  • Coordinated discharge planning, including psychiatric evaluation when appropriate, medication counseling, and follow-up care, supports long-term safety and reduces the risk of recurrence.
  • review
    Bupropion Toxicity. StatPearls [Internet] — Andrew A. Alberter, Andrew J. Chambers, David H. Schaffer — StatPearls Publishing, 2026

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov