Persistent status epilepticus due to bupropion intoxication

Abstract

Bupropion has recently been introduced as an atypical antidepressant and also for use as an aid in smoking cessation. It is a monocyclic and structurally unique antidepressant.¹ Bupropion exhibits pharmacologic actions unlike tricyclic antidepressants or selective serotonin reuptake inhibitors. It is known that bupropion is a selective inhibitor of norepinephrine, dopamine and minimally serotonin reuptake. It also has anticholinergic activity. Its mechanism of action in smoking cessation remains unknown.^1-3

Bupropion is generally a well-tolerated drug and has adverse effects such as headache, dizziness, dry mouth, nausea, constipation, tremors, drowsiness, agitation, insomnia, hallucinations, allergic reactions and seizures. It is associated with a dose-dependent increased incidence of seizures which occur in 0.1% of patients.^4,5 Seizures may result with therapeutic doses of bupropion.⁶However, there are few reports of status epilepticus due to bupropion intoxication with different doses.^7,8

In this report, we present a rare case of long term status epilepticus due to one of the highest dose of bupropion cited in literature that was managed in our intensive care unit (ICU) and survived.