The Poison Review

The Outcomes of Unintentional Pediatric Bupropion Ingestions: A NPDS Database Review.  Meuhler MC et al.  J Med Toxicol (published online 06 March 2010)

(abstract not available online)

Bupropion, an atypical antidepressant, inhibits re-uptake of dopamine and norepinephrine.  It is used as an aid to stop smoking as well as an antidepressant.  Major effects of overdose include decreased mental status, coma, and seizures.  This review of data from the National Poison Data System — covering seven years of cases referred to American poison centers — identified cases of unintentional, acute, single ingestions of bupropion in children < 6 years old.  The authors found 5,964 cases that met inclusion criteria.  There were no deaths, and seizures occurred in only 1.4% of cases.  The incomplete nature of poison center data required to authors to make a number of assumptions. In addition, the data often did not specify what preparation (immediate release, sustained-release) was involved.  In cases that developed seizures, average reported time from ingestion to seizure was 4.1 h (range, 0.5 – 14 h).  The data was not clear on what if any symptoms patients had before they seized.

The authors conclude that in inadvertent acute single ingestions of bupropion in children < 6 years old, reported ingestions of less than 10 mg/kg can be managed at home, and that use of this guideline would avoid 31% of emergency department visits in these cases. This is probably reasonable, but the reader should keep in mind that often the mg/kg calculations in this paper are estimates, and that the final dose reported might not correspond to that offered at the initial phone contact with the poison center.