Most books give bupropion a couple paragraphs, but it arguably deserves its own chapter. With a decrease in the use of tricyclics and increasing use of bupropion XR for depression, bupropion is becoming the most common cause of life-threatening antidepressant overdose. Bupropion has a uniquely dangerous property of blocking gap junctions between cardiomyocytes at high doses, an effect which may cause refractory cardiogenic shock. Combined with the sluggish pharmacokinetics of the extended release formulation (with the potential for delayed, ongoing absorption), this can create a prolonged struggle to keep these folks alive.
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The IBCC chapter is located here.
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Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
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I am curious about the interaction of Wellbutrin and type 1 diabetes. I had a patient with hyperglycemia that was out of control on this. Can you speak to this topic?
Lacey M I don’t see much on a cursory googling. There’s lots of stuff related to wellbutrin for weight loss in the obese, which may improve glycemic control; I didn’t find anything suggesting increased insulin resistance like, say, the atypical antipsychotics. None of the studies on my pubmed perusal or uptodate mention wellbutrin’s intersection with type 1 diabetes specifically (or by extension any direct effect on insulin sensitivity). It’s very hand-wavey to blame “increased sympathetic activity”, but the same way that the catecholamines from stimulant use might cause problems with glycemic control, so too might wellbutrin, on perhaps a less… Read more »