Bupropion: An Atypical Cause of Serotonin Syndrome On behalf of the ACMT Toxicology Investigator’s Consortium Diane P Calello, MD1,3, Alex B Troncoso, MD1,3, Ann-Jeannette Geib, MD2,3 1Morristown Medical Center, Morristown, NJ, USA 2Robert Wood Johnson Medical School, Rutgers, NJ, USA 3Emergency Medical Associates Research Foundation, Parsippany, NJ, USA Introduction Results Discussion Bupropion, an atypical antidepressant, has an There were 67 cases identified, 29 (43%) Although bupropion has negligible effect on unusual mechanism of action that includes male, with the majority of patients (n=50, serotonergic neurotransmission, this series reuptake inhibition of dopamine and 75%) in the 19-65 year age group. There further illustrates what previous case reports norepinephrine, but negligible effects on were 16 cases (24%) under 18 years of age. have described: bupropion may be a causative serotonin neurotransmission. As such, there The circumstances of exposure were agent for serotonin syndrome. This is is debate about whether bupropion can lead Intentional (75%), Unintentional (7%), substantiated by cases in which bupropion was to the serotonin syndrome. Case reports Adverse Drug Reaction or Effect (15%), the sole agent listed. describe serotonin syndrome associated with Unknown or Drug Abuse (1 patient each). In Conclusion bupropion in combination with other 8 cases, bupropion was the only responsible Bupropion does appear** to be associated with serotonergic agents. We sought to describe agent listed. The most common agents listed the serotonin syndrome, both in the case of the characteristics of patients with serotonin in conjunction with bupropion were intentional overdose as well as adverse drug syndrome in association with bupropion as citalopram (n=9) venlafaxine (8), and effects. Avoidance of other serotonergic reported to the Toxicology Investigators’ sertraline (6). The most common classes agents, in particular antidepressants, may be Consortium (ToxIC). involved were antidepressants. Symptoms, prudent in patients on bupropion. Moreover, where reported, included hyperreflexia/ the diagnosis is plausible in a patient with Methods clonus/myoclonus or tremor (69%), delirium suspected bupropion exposure and signs of We accessed the ToxIC registry database for or agitation (58%), tachycardia (51%), and serotonin excess. cases in which “Serotonin syndrome” was seizures (28%). Benzodiazepines were listed identified among the patient’s signs/ as treatment in 66% of cases; 12% of cases symptoms, and for which bupropion was listed cyproheptadine. identified as a primary agent responsible for the patient’s clinical syndrome. The ToxIC registry was established in 2010 and is a multicenter prospective database of cases that were evaluated and treated by a medical toxicologist. .