Abstract

Bupropion, a monocyclic phenylethylamine antidepressant, is the only FDA-approved synthetic cathinone, commonly prescribed as monotherapy or adjunctive therapy for major depressive disorder, seasonal affective disorder, and smoking cessation. Although traditionally considered non-serotonergic, bupropion overdose has been associated with serotonin syndrome (SS), particularly when combined with other serotonergic agents like fluoxetine.


Bupropion overdose may cause tachycardia, QRS widening, and QTc prolongation, but these effects are usually transient and resolve within a few days. Co-ingestion with other drugs can worsen toxicity. Sodium bicarbonate shows inconsistent benefit, and while most patients recover fully, severe cases can occasionally result in fatal arrhythmias.


The management of bupropion toxicity encompasses administration of activated charcoal for recent ingestion, stabilization of cardiovascular and neurological function, and continuous cardiac monitoring due to the potential for arrhythmias and QT interval prolongation. Sodium bicarbonate may be considered in cases of QRS complex widening despite lack of evidence. Benzodiazepines represent the primary therapy for seizure activity and agitation. Supportive care measures—including intravenous fluid administration, correction of electrolyte imbalances, and temperature regulation—are crucial, especially in addressing delayed complications associated with extended-release bupropion formulations.


This case describes a young woman with depression who overdosed on bupropion while taking fluoxetine. She developed recurrent seizures, QT prolongation, ventricular tachycardia, and cardiovascular collapse, ultimately requiring ECMO. Extubation failed on day four, and she died on day seven. The case underscores the risk of

severe complications from bupropion-fluoxetine toxicity, stressing the importance of close monitoring and prompt intervention.