North Carolina Poison Control, Atrium Health, Charlotte, NC, USA.
Central Ohio Poison Center, Columbus, OH, USA.
Clin Toxicol (Phila). 2022 May;60(5):623-627. doi: 10.1080/15563650.2021.2002353. Epub 2021 Nov 23.
Bupropion is a frequently used medication. Excessive doses may cause altered mental status, seizures, and dysrhythmias. There is a need for accurate estimate of seizure risk with therapeutic errors and determination if minor symptoms are harbingers of more severe effects.
A retrospective review of adult, acute, unintentional therapeutic error, single substance bupropion ingestions with known outcome reported to four poison centers from January 1, 2004 to December 31, 2016. Data included age, gender, single error dose, total bupropion dose over 18 h, prior history of seizure, management site, observation time, occurrence of an out-of-hospital adverse event, "jittery"/anxious/agitated, tachycardia/palpitations, seizures, and dysrhythmias. We recorded the total bupropion dose over 18 h if known; otherwise, we used the single error dose. We compared means for parametric data. We used Fisher's exact test and Mann-Whitney for nonparametric data.
We identified 754 potential cases, of which 637 met inclusion criteria after case review. Median age was 42 years, and 76.1% were female. Cases were predominantly managed at home (56.2%). Outcomes were no effect (50.1%), minor (45.5%) and moderate (4.4%). The reported dose with no effect/minor outcome was 694 (±297) mg, and for moderate outcome was 1250 (±815) mg ( < 0.0001). Seizures occurred in four patients with median onset time of 7 h [range 2-21.5 h]. The median reported dose in patients who seized was 900 mg [range 600-3000 mg]. Of patients who developed a seizure and/or an out-of-hospital adverse event, 83% were "jittery"/anxious/agitated whereas "jittery"/anxious/agitated was present in 27% of cases that did not ( = 0.008). Tachycardia/palpitations was reported in 12% of cases; more serious dysrhythmias were not reported.
Outcomes from single unintentional ingestions of bupropion in adults are overall mild and appear to be dose related. Home management may be an option with doses up to 900 mg in an appropriate patient population.
安非他酮是一种常用药物。过量可能导致精神状态改变、癫痫发作和心律失常。需要准确估计治疗错误时的癫痫发作风险，并确定轻微症状是否预示着更严重的影响。
回顾性分析 2004 年 1 月 1 日至 2016 年 12 月 31 日期间，四个中毒中心报告的成人、急性、非故意治疗性错误、单一物质安非他酮摄入，已知结果。数据包括年龄、性别、单一错误剂量、18 小时内的总安非他酮剂量、既往癫痫发作史、管理地点、观察时间、院外不良事件发生情况、“紧张/焦虑/激动”、心动过速/心悸、癫痫发作和心律失常。如果已知，则记录 18 小时内的总安非他酮剂量；否则，使用单一错误剂量。我们比较了参数数据的平均值。对于非参数数据，我们使用 Fisher 精确检验和 Mann-Whitney 检验。
我们共发现 754 例潜在病例，经病例回顾后，其中 637 例符合纳入标准。中位年龄为 42 岁，76.1%为女性。病例主要在家庭管理（56.2%）。结果为无影响（50.1%）、轻微（45.5%）和中度（4.4%）。无影响/轻微结果的报告剂量为 694（±297）mg，中度结果的报告剂量为 1250（±815）mg（ < 0.0001）。4 例患者出现癫痫发作，中位发病时间为 7 小时[范围 2-21.5 小时]。发生癫痫发作和/或院外不良事件的患者中位报告剂量为 900mg[范围 600-3000mg]。发生癫痫发作和/或院外不良事件的患者中，83%表现为“紧张/焦虑/激动”，而未发生这些症状的患者中仅 27%表现为“紧张/焦虑/激动”（ = 0.008）。12%的病例报告有心律过速/心悸，未报告更严重的心律失常。
成人单次非故意摄入安非他酮的结果总体上较轻，且似乎与剂量有关。在家管理可能是一种选择，对于适当的患者人群，剂量可达 900mg。
