Division of Sacramento, California Poison Control System , Sacramento, CA , USA.
Clin Toxicol (Phila). 2014 Nov;52(9):969-72. doi: 10.3109/15563650.2014.969372. Epub 2014 Oct 13.
Seizures of both immediate and delayed onset after ingestion of bupropion SR and bupropion XL formulations are well documented, but are less well characterized after insufflation. Bupropion is crushed and insufflated to experience a high similar to that from amphetamines and cocaine. We sought to characterize the abuse of bupropion via insufflation in cases reported to the California Poison Control System (CPCS) and the incidence of seizures.
An 11-year (2002-2012) retrospective observational case series of insufflated bupropion exposures evaluated in a health care facility (HCF) were reviewed after searching our database for all bupropion insufflation exposures. Patients with coingestants, multiple exposure routes, or age less than 18 were excluded. Data included age, gender, estimated bupropion dose, occurrence of pre-HCF seizures, symptoms and vital signs reported to the CPCS, treatments, and adverse events that occurred until time of discharge.
74 cases were identified (1 excluded due to age, 5 excluded due to additional oral ingestion of bupropion, and 1 excluded due to being unable to follow). A total of 67 cases met inclusion criteria. The median age was 36 (range, 18-65) years. The total dose of bupropion insufflated was reported in 52 pts; median dose of 1500 (range, 100-9000) mg. Eighteen cases (27%) involved staggered or chronic exposures. Of the 67 patients, 20 (30%) experienced a seizure prior to arrival at the HCF. Of these, 19 patients (95%) presented with tachycardia. None of these patients had a second seizure in the emergency department. There were no major medical outcomes and no deaths. Of the 67 patients, 9 patients received benzodiazepines and 6 patients received single-dose activated charcoal.
The abuse of bupropion by crushing and insufflating through the nose is uncommon (67/2270 or 3.0%) compared with that by oral bupropion exposures reported to CPCS. Seizures are common but are self-limited. Delayed seizures (more than 8 h after exposure) appear to be rare. Tachycardia is present in almost all patients who have seizures.
已有充分文献记载，服用安非他酮 SR 和 XL 制剂后会立即和延迟发作癫痫，但经鼻吸入后的情况则不太清楚。安非他酮被压碎后经鼻吸入，可体验到类似安非他命和可卡因的快感。我们试图通过加利福尼亚毒物控制系统（CPCS）报告的病例来描述经鼻吸入安非他酮的滥用情况，并评估癫痫发作的发生率。
对 2002 年至 2012 年在医疗保健机构（HCF）评估的经鼻吸入安非他酮暴露的 11 年回顾性观察性病例系列进行了研究，方法是在我们的数据库中搜索所有安非他酮经鼻吸入暴露的病例。排除了同时摄入其他药物、有多种暴露途径或年龄小于 18 岁的患者。数据包括年龄、性别、估计的安非他酮剂量、HCF 就诊前的癫痫发作、向 CPCS 报告的症状和生命体征、治疗方法以及出院时发生的不良事件。
共发现 74 例病例（1 例因年龄被排除，5 例因同时口服安非他酮被排除，1 例因无法随访被排除）。67 例符合纳入标准。中位年龄为 36 岁（范围，18-65 岁）。52 例患者报告了吸入的安非他酮总剂量；中位剂量为 1500mg（范围，100-9000mg）。18 例（27%）存在间歇性或慢性暴露。67 例患者中，有 20 例（30%）在到达 HCF 之前发生过癫痫发作。其中，19 例（95%）患者出现心动过速。这些患者在急诊科均未再次发生癫痫。无主要医疗结局和死亡。67 例患者中，9 例接受苯二氮䓬类药物治疗，6 例接受单次剂量活性炭治疗。
与 CPCS 报告的口服安非他酮暴露相比，通过压碎和经鼻吸入安非他酮的滥用情况（67/2270 或 3.0%）较为少见。癫痫发作常见，但呈自限性。迟发性癫痫发作（暴露后 8 小时以上）似乎很少见。几乎所有有癫痫发作的患者都有心动过速。
