Written by: Courtney Baldwin (NUEM ‘29) Edited by: Tori Adomshick (NUEM ‘27)
Expert Commentary by: Bernard Weigel, MD
Expert Commentary
Bupropion toxicity is a high-risk ingestion that emergency clinicians must approach with vigilance, given its narrow therapeutic index and propensity for delayed, life-threatening complications. This post appropriately highlights the key neurologic and cardiac manifestations that distinguish bupropion from many other antidepressants, especially the risk of seizures as well as malignant arrhythmias in large ingestions.
From a management standpoint, this review accurately reinforces that there is no specific antidote for bupropion poisoning and that treatment is primarily supportive, with seizure management, airway management, electrolyte monitoring & repletion, and vasopressors (as needed) forming the cornerstone of care. Benzodiazepines should be used liberally for agitation or seizure activity. With regard to cardiotoxicity, clinicians should recognize that QRS prolongation in bupropion toxicity is mechanistically distinct from sodium channel blockade, explaining the often-limited response to sodium bicarbonate. The inclusion of advanced therapies such as circulatory support with VA-ECMO in cases of refractory cardiogenic shock reflects evolving practice patterns and underscores the importance of early toxicology consultation in severe cases.
Finally, the discussion of disposition and observation periods is particularly valuable for frontline providers. Bupropion overdoses are a common source of premature medical clearance, and this post appropriately stresses prolonged monitoring. Overall, this is a concise and clinically relevant overview that reinforces key pearls in bupropion toxicity and serves as an excellent educational resource for emergency medicine providers.
Bernard Weigel, MD
Assistant Professor
Northwestern University Feinberg School of Medicine
Department of Emergency Medicine
How To Cite This Post:
[Peer-Reviewed, Web Publication] Baldwin, C. Adomshick, T. (2026, April 6). Bupropion Toxicity [NUEM Blog. Expert Commentary by Weigel, B]. Retrieved from http://www.nuemblog.com/blog/cb-bupropion.
