Seizures from bupropion

In a review of 37 reported cases, Davidson (426) found that the risk of seizures with bupropion was higher at doses above the recommended maximum (i.e., 450 mg per day). An increased risk of seizures was also noted in eating-disordered patients (i.e., bulimics) on bupropion, leading to its temporary withdrawal from the market. With the immediate release formulation, the seizure risk is four per 1,000 patients when the dose is kept at or below 450 mg per day in those without known risk factors (426, 468). The seizure risk may be as low as one per 1,000 patients with the sustained release formulation when the dose is kept below 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. 

Currenf pracfice suggesfs fhaf pafienfs of normal BMI wifhouf addifional risk facfors for seizures can benefif from bupropion, especially If given prudenf doses of fhe XL formulation such freafmenf should be adminisfered by experts, and patients should be monitored closely and informed of fhe pofenfial risks... 

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... 

In 1986, just prior to its release, seizures were reported in a small number of nondepressed, bulimic patients taking bupropion. Bupropion was removed from the market by the manufacturer until it was determined that seizures in this vulnerable population appeared to be related to high doses (>450 mg) of bupropion used in the context of metabolic instability. The drug was finally released in the United States in 1989. 

Excitation, seizures, delirium, hyperpyrexia, circulatory collapse, coma, and death may result from combining MAO inhibitors wifh mepiridine or dexfromefhorphan Do not combine with another MAO inhibitor, alcohol, buspirone, bupropion, or guanethidine... 

Tricyclics modify peripheral sympathetic effects in two ways through blockade of norepinephrine reuptake at neuroeffector junctions and through alpha adrenoceptor blockade. Sedation and atropine-like side effects are common with tricyclics, especially amitriptyline. In contrast to sedative-hypnotics, tricyclics lower the threshold to seizures. The answer is (B). Selective serotonin reuptake inhibitors cause sexual dysfunction in some patients, with changes in libido, erectile dysfunction, and anorgasmia. Tricyclic antidepressants may also decrease libido or prevent ejaculation. Of the heterocyclic antidepressants bupropion is the least likely to affect sexual performance. The drug is also used in withdrawal from nicotine dependence. The answer is (B). 

Visual hallucinations have been seen in one patient given zolpi-dem with bupropion. Bupropion is contraindicated during the abrupt withdrawal from any drug known to be associated with seizures on withdrawal, particularly benzodiazepines and related drugs. 

Visual hallucinations lasting 3 to 4 hours occurred in a 17-year-oid boy who had been taking bupropion 450 mg daiiy for one month and zolpidem 5 to 10 mg daily for about 6 months, when he increased the zolpidem dose to 60 mg. Note that the recommended dose of zolpidem is 10 mg daily and that zolpidem itself can cause psychiatric adverse effects such as hallucinations. Therefore an interaction is not established. Bupropion is contraindicated during abrupt withdrawal from any drug known to be associated with seizures on withdrawal, particularly benzodiazepines and benzodiazepine-like drugs. ... 

A 29-year-old woman was admitted during withdrawal from intravenous bupropion dependence. She denied experiencing physical withdrawal symptoms, however admitted to physical withdrawal symptoms, irritability, labUity and low mood when abstinent as weU as attending detoxification facilities on 12 occasions to quit bupropion abuse. She had a 2-year history of using bupropion intravenously and admitted to using 1200 mg daily (4 x 300 mg tablets), dissolved in water and injected every 2-3 h (the recommended maximum oral daily dose of 450mg). She denied any history nasal insufflation of bupropion, seizures or exposure in a correctional facility. 

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