• Seizure Risk: Patients can seize 8–24 hours post-ingestion. Neurologic symptoms and tachycardia often precede seizures.
• Delayed Symptoms: Co-ingestions may mask tachycardia, and symptoms can be significantly delayed.
• Key Management Advice:
• Do not discharge patients without consulting a toxicologist or poison center about observation times.
• Do not dismiss tachycardia and anxiety as situational in cases of bupropion overdose.

Key Studies

• Spiller 1994: Review of instant-release bupropion overdoses.
• Shepherd 2004: Seizures predominantly occur with sustained-release products. Most cases had prodromal neuropsychiatric symptoms.
• Starr 2009: Analysis of XL products:
• Symptoms predicting seizures: Tachycardia, tremor, and agitation.
• Tachycardia may be masked by coingestions and symptoms may be very delayed
• Seizures occurred as late as 24 hours, with 25% occurring after 8 hours.
• Offerman 2020: Study of sustained/extended-release products:
• Tachycardia (duration and rate >120 bpm) predicts seizures.
• Hypotension and neuropsychiatric symptoms also predictive.
• Prehospital seizures associated with cardiac arrest—indicative of poor outcomes.
• Rianprakaisang 2021: ToxIC database review of seizure risk factors:
• QTc prolongation and HR >140 bpm are predictive of seizures.

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