Reactions 1315 - 21 Aug 2010

O SBupropion/lorazepam

CNS disorders, heart disorders and respiratoryinsufficiency: 2 case reports

Two patients experienced symptoms including seizures,respiratory insufficiency, tachycardia, heart arrest,hallucinations, bradycardia, confusion, lethargy andagitation after intentionally overdosing with bupropion. Inpatient 1, lorazepam-induced respiratory depression mayhave contributed to a poor outcome.

Patient 1, an 11-year-old girl, was admitted 3.5 hoursafter ingesting an overdose of slow-release bupropion 6g(167 mg/kg). Two hours after overdosing, she experiencedvisual hallucinations and agitation; she subsequentlydeveloped confusion, lethargy, tachycardia, persistentseizure activity and increased respiration rate. She hadbeen receiving bupropion after being diagnosed withattention deficit hyperactivity disorder and ticdisorder, 3 months prior. Intravenous lorazepam 4mg wasinfused for seizure control and activated charcoal wasinitiated. Respiratory failure ensued, due to muscle fatigue,which necessitated mechanical ventilation. She latercollapsed and no palpable pulse was found. Bradycardia(32 beats/min) and an increased QRS duration (> 120msec) were observed. Resuscitation was performed andafter 9 minutes, spontaneous circulation returned. She wastransferred to the ICU; her Glasgow Coma Scale scorewas 3. Despite extensive treatment, she died on the ninthday after the overdose.

Patient 2, a 32-year-old man, was admitted 3 hours afteroverdosing with immediate-release bupropion 6g (64mg/kg). Two hours after overdosing, he experienced aseizure; he subsequently developed lethargy, confusionand slurred speech. His BP was 147/83mm Hg with a HRof 120 beats/min. He had been receiving bupropionfor 3 months for attention deficit hyperactivity disorder.Normal saline and activated charcoal were initiated anddiazepam was readministered following subsequentseizure onset, 6 hours after the overdose. He developedconfusion and agitation, and labetalol was initiated. Onday 2, midazolam was administered and respiratory musclefatigue ensued; mechanical ventilation was started. Testsrevealed an elevated serum creatine phosphokinase level(1627 IU/L). Midazolam was gradually withdrawn and hewas extubated on day 5. His creatine phosphokinase levelnormalised and he was classified as recovered.

Author comment: In the first patient "it is difficult toexclude the possibility that lorazepam-induced respiratorydepression may contribute to the poor outcome."Choi KH, et al. Two cases of severe bupropion overdose. ClinicalPsychopharmacology and Neuroscience 8: 49-52, No. 1, Apr 2010 - SouthKorea 803029642

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Reactions 21 Aug 2010 No. 13150114-9954/10/1315-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved