Recreational bupropion abuse in a teenager

There are a few reports of intentional overdose of the antismoking drug, bupropion (amfebutamone/Zyban) amongst teenage patients, but no reports of recreational use. Significant overdose has led to reports of cardiotoxicity [1], and seizure activity that has resulted in hypoxia and death [2]. A case of overdose is reported in an adolescent girl who took bupropion believing the drug to be a stimulant.

A 13-year old Caucasian girl with a past history of deliberate illicit drug ingestion and evidence of a conduct disorder and mood upset symptoms was admitted to the paediatric ward after intentionally swallowing four bupropion tablets (600 mg total) that were supplied by a friend. She had been persuaded that the tablets would give her a ‘better high than amphetamine’, and had willingly experimented. She had no suicidal intent. She admitted her overdose 10 h after ingestion, and was referred to the local hospital. No adverse effects were reported and clinical examination revealed no abnormalities over a further 16 h period. Serum electrolytes and creatinine were normal. No seizures or side-effects of the bupropion were observed, and she was discharged home the following day.

Bupropion is licensed for smoking cessation and augments validated cessation rates from using a combination of willpower and nicotine replacement therapies [3]. It is a monocyclic antidepressant that is thought to aid smoking cessation by its dopaminergic and noradrenergic effects in the brain [4]. Rather than replacing the nicotine, bupropion increases dopamine levels that fall during cigarette abstinence, thus reducing the ‘craving’ associated with quitting smoking. The reduction in the normal noradrenergic responses to nicotine deprivation seen with bupropion may alter the withdrawal symptoms experienced by the patient. The side-effect profile of bupropion makes it an unlikely candidate for abuse. The adverse events most commonly reported include insomnia, dry mouth, anxiety and dizziness. Indeed, human studies have confirmed that bupropion does not provide any amphetamine-like or stimulant effects [5].

Bupropion overdose has previously been reported as attempted suicide by Ayers et al.[6] who reports a 14 year old who ingested between 1.5 and 3 g. A fatal overdose has been recorded in a man who ingested 23 g that resulted in seizures, hypoxia and cardiac arrest [2]. In the largest published series from Philadelphia, adverse effects including sinus tachycardia, lethargy, tremors and seizures were reported [7].

This case broadens the experience of bupropion overdose in the paediatric population and represents the first documented case of recreational use of bupropion. There is no evidence of other teenagers in the area experimenting with bupropion. This patient did not experience her desired effect, nor did she suffer any adverse effects from her overdose. Although bupropion overdose is rare in the paediatric population, the threshold for toxicity remains to be fully defined.