Bupropion/lorazepam
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Reactions 1315 - 21 Aug 2010 O S Bupropion/lorazepam CNS disorders, heart disorders and respiratory insufficiency: 2 case reports Two patients experienced symptoms including seizures, respiratory insufficiency, tachycardia, heart arrest, hallucinations, bradycardia, confusion, lethargy and agitation after intentionally overdosing with bupropion. In patient 1, lorazepam-induced respiratory depression may have contributed to a poor outcome. Patient 1, an 11-year-old girl, was admitted 3.5 hours after ingesting an overdose of slow-release bupropion 6g (167 mg/kg). Two hours after overdosing, she experienced visual hallucinations and agitation; she subsequently developed confusion, lethargy, tachycardia, persistent seizure activity and increased respiration rate. She had been receiving bupropion after being diagnosed with attention deficit hyperactivity disorder and tic disorder, 3 months prior. Intravenous lorazepam 4mg was infused for seizure control and activated charcoal was initiated. Respiratory failure ensued, due to muscle fatigue, which necessitated mechanical ventilation. She later collapsed and no palpable pulse was found. Bradycardia (32 beats/min) and an increased QRS duration (> 120 msec) were observed. Resuscitation was performed and after 9 minutes, spontaneous circulation returned. She was transferred to the ICU; her Glasgow Coma Scale score was 3. Despite extensive treatment, she died on the ninth day after the overdose. Patient 2, a 32-year-old man, was admitted 3 hours after overdosing with immediate-release bupropion 6g (64 mg/kg). Two hours after overdosing, he experienced a seizure; he subsequently developed lethargy, confusion and slurred speech. His BP was 147/83mm Hg with a HR of 120 beats/min. He had been receiving bupropion for 3 months for attention deficit hyperactivity disorder. Normal saline and activated charcoal were initiated and diazepam was readministered following subsequent seizure onset, 6 hours after the overdose. He developed confusion and agitation, and labetalol was initiated. On day 2, midazolam was administered and respiratory muscle fatigue ensued; mechanical ventilation was started. Tests revealed an elevated serum creatine phosphokinase level (1627 IU/L). Midazolam was gradually withdrawn and he was extubated on day 5. His creatine phosphokinase level normalised and he was classified as recovered. Author comment: In the first patient "it is difficult to exclude the possibility that lorazepam-induced respiratory depression may contribute to the poor outcome." Choi KH, et al. Two cases of severe bupropion overdose. Clinical Psychopharmacology and Neuroscience 8: 49-52, No. 1, Apr 2010 - South Korea 803029642 1 Reactions 21 Aug 2010 No. 1315 0114-9954/10/1315-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
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Transcript of Bupropion/lorazepam
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
