Mini Episode: Who Seizes in Bupropion Overdose with Dr Ari Filip MD

The Poison Lab

1. TL;DR
   1. Your patient can seize 8-24 hours in, usually they have neurologic symptoms and tachycardia before hand
   2. Tachycardia may be masked by coingestions and symptoms may be very delayed
   3. Do not discharge a patient without discussing observation time with a toxicologist or poison center
   4. Do not dismiss tachycardia and anxiety as situational in a bupropion overdose
2. Spiller 1994- Review of instant release product overdoses
3. Shepherd 2004- Seizures in primarily sustained release products
   1. Most seizures had prodromal neuropsychiatric symptoms
4. Starr 2009- Seizure in XL products.
   1. Tachycardia, tremor, agitation most associated with seizures
   2. Seizure occured as late as 24 hours and 25% occurred after 8 hours
5. Offerman 2020- Primarily sustained/extended release products
   1. Tachycardia duration, and extent (>120) predicted seizure. (Hypotnesion and neuropsych symptoms also predict)
   2. Late seizure occurred only in those with symptoms on presentation
   3. Those who had cardiac arrest had prehospital seizure= bad sign
6. Rianprakaisang 2021- ToxIC review of risk factors for seizures
   1. QTc and HR>140 predict seizures