Bupropion seizures with

The occurrence of seizures with bupropion is dose related and may be increased by predisposing factors (e.g., history of head trauma or CNS tumor). At the ceiling dose (450 mg/day), the incidence of seizures is 0.4%. Other side effects include nausea, vomiting, tremor, insomnia, dry mouth, and skin reactions. It is contraindicated in patients with bulimia or anorexia nervosa. 

Bupropion Potential additive effect on lowering of seizure threshold Increased risk of seizure with coadministration Avoid in history of seizure disorder Rosenstein et ah, 1993... 

Much more is known about overdose with the immediate-release formulation of bupropion than with the newer, SR and XL formulations. Reported reactions to overdose with the immediate-release form include seizures, hallucinations, loss of consciousness, and sinus tachycardia. Treatment of overdose should include induction of vomiting, administration of activated charcoal, and electrocardiographic and electroencephalographic monitoring. For seizures, an intravenous benzodiazepine preparation is recommended. 

Bupropion Headache, insomnia, nausea, restlessness, agitation, psychosis, seizure with > 400 mg/day... 

Davidson (426) found that the risk of seizures with bupropion was higher at doses greater than the recommended maximum (i.e., 450 mg per day). The seizure risk may be as low as one per 1,000 patients with the sustained release formulation when the dose is kept less than 450 mg per day, and the patient has no preexisting seizure history and is not on any medication that also can lower seizure thresholds or interfere with the metabolism of bupropion. 

Bupropion Hydrochloride Bupropion interacts with levodopa, nicotine, alcohol, and drugs that affect hepatic metabolic enzymes. It lowers the seizure threshold and potentiates the seizure threshold-lowering effect of other antidepressants.135... 

ANTIPSYCHOTICS BUPROPION t risk of seizures. This risk is marked in elderly people, in patients with a history of seizures, with addiction to opiates/cocaine/ stimulants, and in diabetics treated with oral hypoglycaemics or insulin Bupropion is associated with a dose-related risk of seizures. These drugs, which lower seizure threshold, are individually epileptogenic. Additive effects occur when they are combined Extreme caution. The dose of bupropion should not exceed 450 mg/day (or 150 mg/day in patients with severe hepatic cirrhosis)... 

The report of the myocardial infarction is isolated and of uncertain general significance. Note that the manufacturers of bupropion list stimulants as drugs that increase the risk of seizures with bupropion (see Bupropion + Miscellaneous , below) and this case adds weight to that warning. 

The manufacturers report rare adverse neuropsychiatric events or reduced alcohol tolerance in patients drinking alcohol during bupropion treatment. They recommend that the consumption of alcohol should be minimised or avoided. For comment on the increased risk of seizures with alcohol see (d), below. 

Although clinieal evidence is limited it is supported by in vitro data, and so an interaction would seem to be established. It would seem prudent to be alert for increased trieyelie adverse effects if any of these drugs listed here is given with bupropion, and reduce the tricyclic dose as necessary. Note that bupropion is predicted to increase the risk of seizures with tricyclics, and this effect is dose-related. See Bupropion + Miscellaneous ,... 

Adverse reactions with administration of bupropion include citation, dry mouth, insomnia, headache, nausea, constipation, anorexia, weight loss, and seizures. Fluoxetine administration may result in headache, activation of mania or hypomania, insomnia, anxiety, nervousness, nausea, vomiting, and sexual dysfunction. Trazodone administration may cause the following adverse reactions drowsiness, skin disorders, anger, hostility, anemia, priapism, nausea, and vomiting. Additional... 

Side effects. The primary side effects reported with bupropion administration in cigarette smokers are headache, dry mouth, nausea and vomiting, insomnia, and activation. Although most of these adverse effects occur during the first week of treatment, insomnia can persist. Seizures are of exceedingly low occurrence (<0.5%) at doses of 300 mg daily or less, but a prior history of seizures or a seizure disorder contraindicate its use. 

Isolated seizures that are not epilepsy can be caused by stroke, central nervous system trauma, central nervous system infections, metabolic disturbances (e.g., hyponatremia and hypoglycemia), and hypoxia. If these underlying causes of seizures are not corrected, they may lead to the development of recurrent seizures I or epilepsy. Medications can also cause seizures. Some drugs that are commonly associated with seizures include tramadol, bupropion, theophylline, some antidepressants, some antipsy-chotics, amphetamines, cocaine, imipenem, lithium, excessive doses of penicillins or cephalosporins, and sympathomimetics or stimulants. 

Bupropion causes insomnia, nightmares, decreased appetite, anxiety, and tremors, but the most concerning adverse effect is seizures. Because of the risk for seizures, patients who should not receive the drug include those with a CNS lesion or those with a history of seizures, head trauma, or bulimia. The daily dose of bupropion should not exceed 450 mg/day, and any single dose of the immediate-release formulation should not exceed 150 mg/day Occurrences of insomnia and/or nightmares often respond to moving the last daily dose from bedtime to late afternoon.7,9,22,23... 

The tricyclic antidepressants (TCAs), such as imipramine, can alleviate symptoms of ADHD. Like bupropion, TCAs likely will improve symptoms associated with comorbid anxiety and depression. The mechanism of action of TCAs is in blocking norepinephrine transporters, thus increasing norepinephrine concentrations in the synapse the increase in norepinephrine is believed to alleviate the symptoms of ADHD. TCAs have been demonstrated to be an effective non-stimulant option for ADHD but less effective than stimulants. However, their use in ADHD has declined owing to case reports of sudden death and anticholinergic side effects6,13 (Table 39-3). Further, TCAs may lower seizure threshold and increase the risk of car-diotoxicity, (e.g., arrythmias). Patients starting on TCAs should have a baseline and routine electrocardiograms. 

Bupropion sustained release (SR) is an effective smoking-cessation treatment. It is contraindicated in patients with a seizure disorder, a current or prior diagnosis of bulimia or anorexia nervosa, and use of a monoamine oxidase inhibitor within the previous 14 days. It can be used in combination with NRT. 

The most common side effects of bupropion are decreased appetite and abdominal discomfort. But more serious is the risk of seizure when high doses are taken. For this reason, patients with epilepsy should not take bupropion. 

Bupropion has also been used to treat the eating disorders anorexia nervosa and bulimia nervosa. Unfortunately, their electrolyte abnormalities leave patients with eating disorders especially vulnerable to seizures therefore, bupropion is no longer used to treat them. 

Carbamazepine and possibly the antidepressant mirtazapine should not be coadministered with clozapine because these drugs may further increase the risk of agranulocytosis. In addition, the antidepressant bupropion should not be coprescribed with clozapine because it may increase clozapine s seizure risk. 

---