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Seizures induced by recreational abuse of bupropion tablets via nasal insufflation

Published online by Cambridge University Press:  21 May 2015

Daniel Kim  and
Brian Steinhart
Daniel Kim*
Affiliation:
Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ont.
Brian Steinhart
Affiliation:
Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ont. Department of Emergency Medicine, St. Michael's Hospital, Toronto, Ont.
*
1912–633 Bay St, Toronto ON M5G 2G4; [email protected]

Abstract

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Bupropion is a newer generation antidepressant that is commonly used for treatment of depression and for smoking cessation. Seizures are a frequently reported adverse effect of bupropion in therapeutic oral doses; however, there are limited data about the consequences of nasal insufflation of bupropion. We report the case of a patient who presented to the emergency department (ED) with a recent history of generalized tonic–clonic seizures whose etiology was initially a diagnostic mystery. After an initial visit to another ED, the patient presented to our ED later that day with a recurrence of the seizures after crushing and nasally insufflating oral bupropion tablets. We review important implications of this case to emergency medicine, including the potential for abuse of bupropion, the difference between intranasal and oral administration, the changing trends in the etiology of drug-related seizures and the importance of examining the nares in patients with unexplained seizure and delirium.

Keywords

bupropionseizurenasal insufflationnares
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 2 , March 2010 , pp. 158 - 161
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

References

REFERENCES

1.Preskorn, SH, Othmer, SC. Evaluation of bupropion hydrochloride: the first of a new class of atypical antidepressants. Pharmacotherapy 1984;4:20–34.Google Scholar
2.Cooper, BR, Hester, TJ, Maxwell, RA. Behavioral and biochemical effects of the antidepressant bupropion: evidence for selective blockade of dopamine uptake in vivo. J Pharmacol Exp Ther 1980;215:127–34.Google ScholarPubMed
3.Soroko, FE, Mehta, NB, Maxwell, RA, et al. Bupropion hydrochloride: a novel antidepressant agent. J Pharm Pharmacol 1977;29:767–70.Google Scholar
4.Griffith, JD, Carranza, J, Griffith, C, et al. Bupropion clinical assay for amphetamine-like abuse potential. J Clin Psychiatry 1983;44:206–8.Google Scholar
5.Peck, AW, Bye, CE, Clubley, M, et al. A comparison of bupropion hydrochloride with dexamphetamine and amitryptyline in healthy subjects. Br J Clin Pharmacol 1979;7:469–78.Google Scholar
6.Miller, L, Griffith, J. A comparison of bupropion, dextroamphetamine, and placebo in mixed-substance abusers. Psychopharmacology 1983;80:199–205.CrossRefGoogle ScholarPubMed
7.Del Paggio, D. Psychotropic medication abuse in correctional facilities. Bay Area Psychopharmacol Newsletter 2005;8:1–6.Google Scholar
8.Babcock, Q, Byrne, T. Student perceptions of methylphenidate abuse at a public liberal arts college. J Am Coll Health 2000;49:143–5.CrossRefGoogle Scholar
9.Hill, S, Sikand, H, Lee, J. A case report of seizure induced by bupropion nasal insufflation. Prim Care Companion J Clin Psychiatry 2007;9:67–9.CrossRefGoogle ScholarPubMed
10.Khurshid, KA, Decker, DH. Bupropion insufflation in a teenager. J Child Adolesc Psychopharmacol 2004;14:157–8.CrossRefGoogle Scholar
11.Welsh, CJ, Doyon, S. Seizure induced by insufflation of bupropion. N Engl J Med 2002;347:951.CrossRefGoogle ScholarPubMed
12.Davidson, J. Seizures and bupropion: a review. J Clin Psychiatry 1989;50:256–61.Google Scholar
13.Johnston, JA, Lineberry, CG, Ascher, JA, et al. A 102-center prospective study of seizure in association with bupropion. J Clin Psychiatry 1991;52:450–6.Google Scholar
14.Spiller, HA, Ramoska, EA, Krenzelok, EP, et al. Bupropion overdose: a 3-year multi-center retrospective analysis. Am J Emerg Med 1994;12:43–5.CrossRefGoogle ScholarPubMed
15.Storrow, AB. Bupropion overdose and seizure. Am J Emerg Med 1994;12:183–4.Google Scholar
16.Harris, CR, Gualtieri, J, Stark, G. Fatal bupropion overdose. J Toxicol Clin Toxicol 1997;35:321–4.CrossRefGoogle ScholarPubMed
17.Wermeling, DP, Record, KA, Archer, SM, et al. A pharmacokinetic and pharmacodynamic study, in healthy volunteers, of a rapidly absorbed intranasal midazolam formulation. Epilepsy Res 2009;83:124–32.CrossRefGoogle ScholarPubMed
18.Graff, CL, Pollack, GM. Nasal drug administration: potential for targeted central nervous system delivery. J Pharm Sci 2005;94:1187–95.CrossRefGoogle ScholarPubMed
19.Bryant, SG, Guernsey, BG, Ingrim, NB. Review of bupropion. Clin Pharm 1983;2:525–37.Google ScholarPubMed
20.Pesola, GR, Avarsarala, J. Bupropion seizure proportion among new-onset generalized seizures and drug related seizures presenting to an emergency department. J Emerg Med 2002;22:235–9.Google Scholar
21.Lowenstein, DH, Alldredge, BK. Status epilepticus at an urban public hospital in the 1980s. Neurology 1993;43:483–8.Google Scholar
22.Olson, KR, Kearney, TE, Dyer, JE, et al. Seizures associated with poisoning and drug overdose. Am J Emerg Med 1994;12:392–5.Google Scholar
23.Thundiyil, JG, Kearney, TE, Olson, KR. Evolving epidemiology of drug-induced seizures reported to a poison control center system. J Med Toxicol 2007;3:15–9.Google Scholar
24.Preskorn, SH. Antidepressant response and plasma concentrations of bupropion. J Clin Psychiatry 1983;44:137–9.Google ScholarPubMed
25.Kunisaki, T, Augenstein, W. Seizures. In: Ford, M, DeLaney, K, Ling, L, et al., editors. Clinical toxicology. 1st ed. Philadelphia (PA): WB Saunders; 2001. p. 155–67.Google Scholar