May 22 2022

Adverse reactions to Bupropion

  • 1. Accidental cardiotoxicity
  • Case report: A child accidentally took large doses of medication presenting bradycardia, hypotension and seizures.

  • 2. Acute bradycardia
  • In one patient treated with metoprolol and bupropion. Relationship not well established. It could be a drug interaction.

  • 3. Acute dystonia
  • Case report: For discontinuation. The patient had trismus, torticollis and dysphagia.

  • 4. Acute hepatitis
  • Case report: At six weeks of initiation of treatment with bupropion for depression, the patient developed acute hepatitis (elevated transaminases, LDH, etc.). Not set the actual incidence of this complication, although considered low..

  • 5. Adverse reactions associated with bupropion overdose
  • A study conducted on 476 patients who consumed extra doses of the drug (75-1500 mg) reported 4 patients with seizures (0.8%), one developed status epilepticus. 39 patients had agitation (8.2%), 35 patients had dizziness (7.4%), in 34 cases there was tremor (7.1%), while in 32 cases there was sickness and vomit. 29 patients suffered from sleepiness; 26 cases of tachycardia and in two cases were hallucinations. Overall, 183 patients (38.4%) experienced at least one adverse effect. Doses were higher in those who suffered such adverse effects that in the not suffered (p = 0.045).

    It can be concluded that the adverse effects were common with extra dose, with significant effects one in ten patients. Seizures, as noted above, were two times more likely than therapeutic doses.

  • 6. Adverse reactions requiring discontinuation
  • In placebo-controlled clinical trials, 9-11% of patients had to stop treatment due to an adverse event (placebo = 4%). Common causes of discontinuance of treatment include skin rashes, sickness, migraine and agitation.

  • 7. Aggressive behavior
  • Unexpected. case report: by association with alcohol.

  • 8. Agitation and insomnia
  • Are possible the appearance of restlessness, agitation, anxiety and insomnia, especially when starting treatment. Sometimes also requires specific treatment. 1-2.6% of the patients treated with 300 and 400 mg / day respectively had to discontinue treatment by these effects.

  • 9. Allergic reactions
  • In premarketing trials have been reported hypersensitivity reactions such as pruritus, urticaria, angioedema and dyspnoea that may require medical attention. There have been rare cases of Stevens-Johnson syndrome, and anaphylactic shock associated with bupropion use.

    We interpret articular manifestations (arthritis, arthralgia) and muscles (myalgia) are suggestive of delayed hypersensitivity. Demonstrations occur occasionally reminiscent serum sickness..

  • 10. Alteration of laboratory tests
  • False positive tests for LSD and amphetamines.

  • 11. Altered appetite and weight
  • Both may show loss of appetite and weight as the opposite.

  • 12. Angioedema
  • Case report: A 33 year old male presented angioedema during smoking cessation treatment.

  • 13. Anisocoria
  • Case report: A 40 year old woman with a history of migraines presented unilateral mydriasis while receiving bupropion .

  • 14. Aphthous ulcers
  • Case report on a teenager. The symptoms disappeared after stopping treatment and reappeared after a reboot.

  • 15. Arterial hypertension
  • Bupropion treatment was associated with hypertension that may require treatment, especially in patients who use nicotine in combination with bupropion concurrently. It is estimated that the incidence of hypertension in patients treated with both nicotine and bupropion extended release is 6.1%, double that of patients treated with bupropion alone. In most cases the patients had history of hypertension.

  • 16. Bupropion common adverse reactions (5% or more of patients and at least twice placebo)
  • Anorexia, dry mouth, rash, sweating, tinnitus, tremor, abdominal pain, agitation, anxiety, dizziness, insomnia, muscle pain, sickness, palpitations, pharyngitis and frequent urination.

  • 17. Cardiogenic shock and status epilepticus
  • Overdose case report: A 35 years old male admitted in a coma after ingesting 12 grams of Bupropion. The patient presented a severe and prolonged status epilepticus and cardiogenic shock..

  • 18. Chest pain
  • There have been several cases of chest pain associated with the use of Bupropion, without having been able to establish a production mechanism.

  • 19. Cholestatic hepatitis
  • Three weeks after starting treatment.

  • 20. Clinical worsening and suicide risk
  • Patients with major depression may experience worsening of their depression and suicidal ideation and behavior. .. They can also suffer marked changes in behavior, whether or not they take take antidepressant medications. Antidepressant medications play a role in the worsening of depression and suicidal behavior in early stages of treatment in some patients, especially in children, adolescents and young adults.

  • 21. Common adverse reactions to bupropion (1% or greater)
  • Akathisia, Accident, Acne, Taste changes, cardiac arrhythmias, Arthralgia, Arthritis, Increased Appetite, Bronchitis Confusion, depression, diarrhea, diplopia, dysphagia, dysmenorrhea, decreased libido, decreased memory, Dyspepsia, Headache, neck pain, back pain, constipation, nervous excitation, fever, flatulence, vaginal bleeding,.

  • 22. Delirium
  • Case report: Characterized by disorganized thinking, impaired memory, fear and agitation. The symptoms are dose-dependent, so that low doses could allow continued treatment of this patient..

  • 23. Depression
  • There have been several cases of severe depression in the course of two multicenter trials with bupropion to quit snuff..

  • 24. Eosinophilia
  • Case report: A patient developed rash, eosinophilia and systemic syndrome including acute hepatitis, myositis and obstructive pulmonary disease. Bupropion interruption and corticosteroids allow recovery. Another 72 year old patient presented during hospitalization in the hospital a percentage of 60% eosinophils, with 6693 eosinophils per mm3..

  • 25. Erythema multiforme
  • Case report.

  • 26. Exacerbation of psoriasis with Stevens-Johnson syndrome
  • Case report: A 56 year old woman presented an acute exacerbation of psoriasis and SJS syndrome induced by Bupropion taken to treat depression.

  • 27. Exacerbation of tics
  • Bupropion exacerbates tics in children with attention deficit disorder, hyperactivity and also in Tourette's syndrome (4 cases report)..

  • 28. Exitus
  • Potential risk of overdose. Cases associated with concomitant use of alcohol.

  • 29. Extrapyramidal symptoms
  • A published study includes 89 cases of extrapyramidal symptoms with antidepressants. In 6% was involved bupropion.

  • 30. Fall back
  • Case report: Two patients experienced falls backwards after starting treatment with bupropion. In both cases presented parkinsonian disorders. It is considered likely its relation to dopaminergic effects in the basal ganglia.

  • 31. Fatal acute liver failure
  • Case report. By taking bupropion and carbimazole together.

  • 32. Functional alteration trigeminal
  • Case report: A patient treated with 300 mg/day for a month, filed a trigeminal sensory impairment, who disappeared on removal and reappeared to reintroduce.

  • 33. Generalized pustular and erythrodermic psoriasis
  • Case report.

  • 34. Intraventricular conduction delay
  • Possible delay by overdose. A case report in a patient who ingested 9 grams of the drug. Also presented a neurotoxic syndrome.

    Often a moderate prolongation of QTc using bupropion overdose (> 440 ms). However, this may not be due to cardiotoxicity but QTc overcorrection due to tachycardia.

    Has published a case of QRS prolongation unresponsive to the administration of NaHCO3.

  • 35. Joint pain
  • Case report: Three patients had delayed hypersensitivity reactions reminded serum sickness, associated with urticaria, arthralgia and fever. One patient presented with monoarthritis of the wrist, which started a few days you start taking bupropion.

  • 36. Mania
  • Antidepressants can precipitate manic episodes in patients with bipolar disorder during depressive phases of the illness. Bupropion shares these risks.

  • 37. Menstrual irregularities
  • Infrequent.

  • 38. Myocardial Infarction
  • Case report: A patient receiving both methylphenidate and erythromycin. Another case in a 21 year old male receiving pseudoephedrine also for catarrh..

  • 39. Neonatal hyperinsulinism
  • In a newborn, associated with exposure during pregnancy to bupropion without associated risk factors.

  • 40. Neuroleptic malignant syndrome
  • Very rare.

  • 41. Organic mental disorders
  • Characterized by visual disturbances, hallucinations and visual illusions and even hearing..

  • 42. Other neuropsychiatric symptoms
  • May appear hallucinations, psychosis, difficulty concentrating, confusion and paranoid ideas. It is sometimes possible to remove these manifestations withdrawing or reducing the dose of the drug.

  • 43. Pseudo cerebral stroke
  • Case report: A male of 67 years presented dizziness, paresthesias, tinnitus, confusion and altered gait after starting treatment with bupropion to leave the snuff. Clinical and radiological examinations were negative. The condition resolved to recur to reintroduce the drug.

  • 44. Psychosis / Acute psychosis
  • Psychotic disorders appear to the tenth day of treatment with 300 mg / day. In two of three cases the patients have no psychiatric history, while the rest have usually a history of dysthymic disorder, according to a review of cases.

    The 85% of patients have visual, auditory or kinesthetic hallucinations. The patients were agitated and confused, but rarely have dissociative symptoms or dysthymia.

    4 cases of acute psychosis, at least two of them, at therapeutic doses. The mechanism may be related to alterations in dopaminergic systems. A case of intentional overdose in a teenager was followed by hallucinations and tachycardia. Another case report in a patient with schizoaffective disorder who experienced two psychotic type episodes within four days after starting treatment with 150 mg of extended-release bupropion to leave the snuff.

  • 45. Rare adverse reactions to bupropion
  • Aphasia, aggression, akinesia, Alopecia, Disturbance of coagulation (INR, PT) associated with thrombotic or hemorrhagic complications when coadministered with anticoagulants, hallucinations, amnesia, anemia, angioedema, Ataxia, Increased libido, complete atrioventricular block, bronchospasm, Cystitis, Colitis, Coma, suicidal behavior, liver damage, delirium, dermatitis exfoliative, Derealization, Diplopia, dyspareunia, Dyskinesia, Tardive dyskinesia, dysarthria, dystonia, dysuria, tongue edema, abnormal EEG (20% of one sample representative EEG abnormalities presented asymptomatic), elevation of intraocular pressure, pulmonary embolism, painful erection, maculopapular rash, esophagitis, extrasystole, abnormal ejaculation, phlebitis, Gynecomastia, Glycosuria, gastrointestinal bleeding, Hepatitis, hyperglycemia, hypoglycemia , Hypomania, Hypokinesia, hypotension, hirsutism, paranoid ideation, illusions, impotence, urinary incontinence, Myocardial infarction, Restlessness, leukocytosis, leukopenia, lymphadenopathy, Malaise, Mania, Menopause, myalgia, mydriasis, prostatic discomfort, Pneumonia, neuralgia, neuropathy, pancytopenia, pancreatitis, intestinal perforation, polyuria, urinary retention, muscle stiffness associated with fever, rhabdomyolysis and muscle weakness, salpingitis, Syncope, extrapyramidal syndrome, syndrome similar to serum sickness, deafness, Thrombocytopenia, stomach ulcers and Vaginitis.

  • 46. Refractory hypotension
  • An infant of 11 months of age presented convulsions, acute respiratory failure and severe hypotension with metabolic acidosis after taking an accidental overdose of 750 mg / kg.

  • 47. Rhabdomyolysis
  • Case report in a patient following a treatment to stop the snuff.

  • 48. Seizures
  • The risk of seizures is dose dependent on bupropion. Also influence the patient's previous state and the concomitant use of other drugs. At doses up to 300 mg / day, the incidence of seizures is 0.1%. At doses up to 50% greater, the incidence rises to 0.4%. This figure is significantly higher than that of other antidepressants. At higher doses (450-600 mg / day), the incidence of seizures is multiplied by 10.

    There have been reports of grand mal seizures for extended-release presentations, seizures associated with sleep deprivation, with downloads bitemporal seizures, multiple seizures overdose in small children, by aspiration of nasal drug (recreational), prolonged seizures by the Concurrent use of clomipramine or Bupropion associated with lithium and venlafaxine.

    case report in infants to pass through breast milk.

  • 49. Serotonin syndrome
  • Case reports associated with SSRI or in monotherapy.

  • 50. Serum sickness-like reaction
  • Several case reports in the literature.

  • 51. Severe and refractory hypotension
  • In one case of overdose.

  • 52. Severe constipation
  • Severe but rare symptom.

  • 53. Skin rash with eosinophilia and general Involvement
  • Case report: The patient had, in addition to the rash, eosinophilia, acute hepatitis, obstructive lung disease and myositis.

  • 54. Somnambulism
  • Case report associated with concomitant food intake.

  • 55. Stevens-Johnson syndrome
  • Very rare.

  • 56. Subcutaneous lupus erythematosus
  • Case report: A 44 year old woman presented a history of photosensitive rash and itching from nine weeks before, begun in the chest. A month before the beginning of the eruption started taking Bupropion for an episode of depresesi?n. The patient also noted multiple erythematous annular plaques on the chest, shoulders, back, and face.

  • 57. Suicide
  • Antidepressants increase the risk of suicidal thinking and suicide compared with placebo in children, adolescents and young adults in short-term studies. Depression itself is a risk factor for suicidal ideation and suicide.

    There have been serious adverse reactions, besides suicidal ideation with the use of bupropion for antismoking therapy. Some cases may worsen when added nicotine withdrawal. There have also been rare cases of suicidal ideation in patients with nicotine withdrawal without using drugs.

  • 58. Thrombocytopenic purpura associated with hemolytic-uremic syndrome
  • Case report: In the course of anti-smoking treatment.

  • 59. Uncommon adverse reactions to bupropion (less than 1%)
  • Hypotension, Hostility, urinary tract infections, irritability, migraine, menstrual discomfort, nervousness, paresthesia, sleep quality loss, pruritus, rhinitis, flu syndrome, sinusitis, Flushing, sleepiness, abnormal dreams, tachycardia, cough, dental disorders, respiratory disorders, sensory disorders (vision, taste), urinary urgency, urticaria, vision blurred and vomit.