Department of Emergency Medicine, University of Iowa, Iowa City, Iowa; Iowa Poison Control Center, Sioux City, Iowa.
Department of Emergency Medicine, University of Calgary, Calgary AB, Canada; Poison and Drug Information Service, Section of Clinical Pharmacology and Toxicology, University of Calgary, Calgary, Alberta, Canada.
J Emerg Med. 2022 Feb;62(2):175-181. doi: 10.1016/j.jemermed.2021.07.052. Epub 2021 Sep 15.
Bupropion is an antidepressant medication with expanding indications including smoking cessation, weight loss, attention-deficit/hyperactivity disorder, seasonal affective disorder, and amphetamine dependence. Despite its increasing popularity among providers, it has a well-known narrow therapeutic window that can lead to delayed onset of symptoms with extended-release formulations and devastating consequences in overdose. We have noticed some patients misusing bupropion via insufflation, which added a layer of complexity with regards to the therapeutic application of the drug. This route of use created difficult decisions regarding clinical monitoring in these patients.
To determine if prolonged observation is required after insufflation of bupropion and to further describe effects from this route of use.
This is a retrospective observational study reviewing all the cases of insufflated bupropion use reported to a single poison center without any other coingestants.
The majority (85.7%) of patients had mild or moderate effects, and seizures occurred in 19.6% of cases; and the vast majority of patients were symptomatic by the time of the initial call to the poison center. We did not encounter any delayed effects after this route of use.
This report describes the clinical effects reported, and the timing of these effects, after insufflation of bupropion.
安非他酮是一种抗抑郁药，其适应证不断扩大，包括戒烟、减肥、注意力缺陷多动障碍、季节性情感障碍和苯丙胺依赖。尽管它在提供者中越来越受欢迎，但它的治疗窗很窄，这可能导致缓释制剂的症状延迟出现，并在过量使用时造成毁灭性的后果。我们注意到一些患者通过鼻吸来滥用安非他酮，这给药物的治疗应用增加了一层复杂性。这种使用途径给这些患者的临床监测带来了困难的决策。
确定鼻吸安非他酮后是否需要延长观察时间，并进一步描述这种使用途径的效果。
这是一项回顾性观察研究，审查了向单一中毒中心报告的所有鼻吸安非他酮使用病例，没有任何其他共服药物。
大多数（85.7%）患者出现轻度或中度影响，19.6%的病例发生癫痫发作；绝大多数患者在首次致电中毒中心时就出现了症状。我们没有遇到任何使用这种途径后的延迟影响。
本报告描述了鼻吸安非他酮后报告的临床影响及其发生时间。
