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. 2010 Mar 18;6(2):168–171. doi: 10.1007/s13181-010-0021-x

Bupropion Induced Serotonin Syndrome: A Case Report

Elizabeth L Thorpe 1, Anthony F Pizon 1,2,✉, Michael J Lynch 1,2, Jessica Boyer 3
PMCID: PMC3550303  PMID: 20238197

Abstract

Although there are no documented cases of serotonin syndrome (SS) following bupropion ingestion alone in the literature, the ability of bupropion to potentiate serotonin levels and lead to SS is known. A 15-year-old boy was found at home hallucinating. He then developed tonic–clonic activity. Upon arrival in the emergency department, he was confused and restless. On exam, he had tachycardia, hypertension, dilated pupils and dry oral mucosa, normal tone and reflexes in his arms, but rigidity and +4 reflexes in his legs with sustained clonus at his ankles. He was admitted and treated with intravenous fluids and lorazepam for his agitation. A urine drug screen (via gas chromatography/mass spectrometry) was positive only for naproxen and bupropion. Serum bupropion and hydroxybupropion levels drawn 17 h after his reported ingestion were 280 (therapeutic range 50–100) and 3,100 ng/mL (therapeutic range <485), respectively. Within 24 h of his admission, the patient was awake with normal vital signs and neurologic exam. To our knowledge, there are only three reported cases demonstrating SS in conjunction with bupropion toxicity; however, none of these were secondary to bupropion alone.

Keywords: Bupropion, Serotonin syndrome, Pediatrics

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Footnotes

Funding Sources: None

Accepted as a poster presentation for the North American Congress of Clinical Toxicology Annual Meeting 2009, San Antonio, TX, USA.

References

  • 1.Martin TG. Serotonin syndrome. Ann Emerg Med. 1996;28:520–526. doi: 10.1016/s0196-0644(96)70116-6. [DOI] [PubMed] [Google Scholar]
  • 2.Boyer EW, Shannon M. The serotonin syndrome. NEJM. 2005;352:1112–1120. doi: 10.1056/NEJMra041867. [DOI] [PubMed] [Google Scholar]
  • 3.Giese SY, Nebrosky R. Serotonin syndrome: potential consequences of Meridia combined with demorol or fentanyl. Plast Reconst Surg. 2001;107:293–294. doi: 10.1097/00006534-200101000-00069. [DOI] [PubMed] [Google Scholar]
  • 4.DeSilva KE, Le Flore DB, Marston BJ, et al. Serotonin syndrome in HIV infected individuals receiving antiretroviral therapy and fluoxetine. AIDS. 2001;15:1281–1285. doi: 10.1097/00002030-200107060-00010. [DOI] [PubMed] [Google Scholar]
  • 5.Lee DO, Lee CD. Serotonin syndrome in a child associated with erythromycin and sertraline. Pharmacotherapy. 1999;19:894–896. doi: 10.1592/phco.19.10.894.31561. [DOI] [PubMed] [Google Scholar]
  • 6.Lane R, Baldwin D. Selective serotonin reuptake inbitibor-induced serotonin syndrome: review. J Clin Psychopharmacol. 1997;17:208–221. doi: 10.1097/00004714-199706000-00012. [DOI] [PubMed] [Google Scholar]
  • 7.Gill M, LoVecchio F, Selden B. Serotonin syndrome in a child after a single dose of fluvoxamine. Ann Emerg Med. 1999;33:457–459. doi: 10.1016/s0196-0644(99)70313-6. [DOI] [PubMed] [Google Scholar]
  • 8.Mitchell PB. Drug interactions of clinical significance with selective serotonin reuptake inhibitors. Drug Saf. 1997;17:390–406. doi: 10.2165/00002018-199717060-00005. [DOI] [PubMed] [Google Scholar]
  • 9.Munhoz RP. Serotonin syndrome induced by a combination of bupropion and SSRI’s. Clin Neuropharmacol. 2004;27:219–222. doi: 10.1097/01.wnf.0000142754.46045.8c. [DOI] [PubMed] [Google Scholar]
  • 10.Szakaly D, Strauss R. Serotonin syndrome in the oral and maxilofacial surgery office: a review of the literature and report of a case. J Oral Maxillofac Surg. 2008;66:1949–195. doi: 10.1016/j.joms.2008.01.016. [DOI] [PubMed] [Google Scholar]
  • 11.Dvir Y, Smallwood P. Serotonin syndrome: a complex but easily avoidable condition. Gen Hosp Psych. 2008;30:284–287. doi: 10.1016/j.genhosppsych.2007.09.007. [DOI] [PubMed] [Google Scholar]
  • 12.Balit CR, Lynch CN, Isbister GK. Bupropion poisoning: a case series. Med J Aust. 2003;178(2):61–63. doi: 10.5694/j.1326-5377.2003.tb05064.x. [DOI] [PubMed] [Google Scholar]
  • 13.Belson MG, Kelley TR. Bupropion exposures: clinical manifestations and medical outcome. J Emer Med. 2002;23:223–230. doi: 10.1016/s0736-4679(02)00522-x. [DOI] [PubMed] [Google Scholar]
  • 14.Horst WD, Preskorn SH. Mechanisms of action and clinical characteristics of three atypical antidepressants: venlafaxine, nefazodone, buproion. J Affect Disord. 1998;51:237–254. doi: 10.1016/s0165-0327(98)00222-5. [DOI] [PubMed] [Google Scholar]
  • 15.Ascher JA, Cole JO, et al. Bupropion: a review of its mechanism of antidepressant activity. J Clin Psychiatry. 1995;56(9):395–401. [PubMed] [Google Scholar]
  • 16.El Mansari M, Ghanbari R, et al. Sustained administration of bupropion alters the neuronal activity of serotonin, norepinephrine but not dopamine neurons in the rat brain. Neuropharmacology. 2008;55(7):1191–8. doi: 10.1016/j.neuropharm.2008.07.028. [DOI] [PubMed] [Google Scholar]
  • 17.Cooper BR, Wang CM, et al. Evidence that the acute behavioral and electrophysiologic effects of bupropion are mediated by a noradrenergic mechanism. Neuropsychopharmacology. 1994;11:133–141. doi: 10.1038/npp.1994.43. [DOI] [PubMed] [Google Scholar]
  • 18.Dong J, Blier P. Modification of norepinephrine and serotonin, but not dopamine, neuron firing by sustained bupropion treatment. Psychopharmacology. 2001;155:52–57. doi: 10.1007/s002130000665. [DOI] [PubMed] [Google Scholar]
  • 19.Ayers S, Tobias JD. Bupropion overdose in an adolescent. Pediatr Emerg Care. 2001;17(2):104–106. doi: 10.1097/00006565-200104000-00006. [DOI] [PubMed] [Google Scholar]
  • 20.Givens ML, Gabrysch J. Cardiotoxicity associated with accidental bupropion ingestion in a child. Pediatr Emerg Care. 2007;23(4):234–237. doi: 10.1097/PEC.0b013e31803f5a83. [DOI] [PubMed] [Google Scholar]
  • 21.Spiller HA, Schaeffer SE. Multiple seizures after bupropion overdose in a small child. Pediatr Emerg Care. 2008;24(7):474–475. doi: 10.1097/PEC.0b013e31817de2e6. [DOI] [PubMed] [Google Scholar]
  • 22.Stahl SM, Pradko JF, et al. A review of the neuropharmacology of bupropion, a dual norepinephrine and dopamine reuptake inhibitor. Prim Care Companion J Clin Psychiatry. 2004;6(4):159–166. doi: 10.4088/pcc.v06n0403. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Piacentini MF, Clinckers R, Meeusen R, et al. Effect of bupropion on hippocampal neurotransmitters and on peripheral hormonal concentrations in the rat. J Applied Physiol. 2003;95:652–656. doi: 10.1152/japplphysiol.01058.2002. [DOI] [PubMed] [Google Scholar]
  • 24.Foley KF, DeSanty KP, Kast RE. Bupropion: pharmacology and therapeutic applications. Expert Rev Neurother. 2006;6(9):1246–1265. doi: 10.1586/14737175.6.9.1249. [DOI] [PubMed] [Google Scholar]
  • 25.Radomski JW, Dursun SM, Reveley MA, Kutcher SP. An exploratory approach to the serotonin syndrome: an update of clinical phenomenology and revised diagnostic criteria. Med Hypotheses. 2000;55(3):218–24. doi: 10.1054/mehy.2000.1047. [DOI] [PubMed] [Google Scholar]
  • 26.Sternbach H. The serotonin syndrome. Am J Psychiatry. 1991;148:705–713. doi: 10.1176/ajp.148.6.705. [DOI] [PubMed] [Google Scholar]
  • 27.Horowitz BZ, Mullins ME. Cyproheptadine for serotonin syndrome in an accidental pediatric sertraline ingestion. Pediatr Emerg Care. 1999;15:325–327. doi: 10.1097/00006565-199910000-00006. [DOI] [PubMed] [Google Scholar]

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