The Pharm So Hard Emergency Medicine & Hospital Pharmacy Podcast Episode 107. Bupropion Toxicity with Thom Maciulewicz
Sep 5, 2023
Thom Maciulewicz, a clinical pharmacist with expertise in toxicology, dives into the complexities of bupropion. He explains its dual action as a dopamine/norepinephrine reuptake inhibitor and shares how its formulations can impact seizure risks. Thom highlights critical signs of impending seizures and offers a thorough guide on emergency department protocols for bupropion toxicity. The discussion also includes innovative rescue therapies like lipid emulsion and ECMO for severe cases, making for a compelling listen on overdose management.
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Bupropion Can Mimic Other Toxidromes
- Thom recounts patients presenting with anticholinergic or serotonergic signs despite bupropion's lack of serotonin activity.
- He highlights how toxicology cases can mislead clinicians because bupropion produces diverse, deceptive presentations.
QRS Prolongation Mechanism Remains Uncertain
- Mechanism of QRS prolongation is unclear: connexin-43 gap junction inhibition was proposed but not consistently supported.
- Sodium bicarbonate sometimes shortens QRS but is inconsistently effective in bupropion toxicity.
Recognize Early Warning Signs For Seizures
- Watch for early warning signs of seizures: tachycardia, tremor, agitation, hallucinations, and high QTc.
- Use those signs to proactively monitor and prepare benzodiazepines before seizures start.