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Bupropion is an antidepressant medication that has received FDA approval for the treatment of depression and seasonal affective disorder and as an aid for smoking cessation. Since its approval in 1985, bupropion has been utilized off-label for various conditions, including antidepressant-induced sexual dysfunction, depression associated with bipolar disorder, obesity, and ADHD in pediatric patients. This activity reviews bupropion's clinical applications, including indications, dosing, mechanism of action, adverse event profile, and toxicity. By understanding bupropion's pharmacological properties, healthcare professionals can optimize treatment regimens and reduce the risk of adverse effects, thereby improving patient outcomes. The activity also emphasizes the essential role of the interprofessional healthcare team in managing bupropion therapy, underlining the significance of collaboration and well-defined roles in patient care. Objectives: Identify the FDA-approved and off-label indications of bupropion. Assess the mechanism of action of bupropion. Screen patients for contraindications and potential risks associated with bupropion therapy. Implement effective collaboration and communication among interprofessional team members to improve outcomes and treatment efficacy for patients who might benefit from bupropion therapy. Access free multiple choice questions on this topic.

Signs and Symptoms of Overdose There is extensive published data regarding bupropion overdose.[57] The more severe exposures typically occur in an intentional overdose setting. With supportive care, unintentional overdoses usually lead to no significant effects. Accidental exposures in children are rare; a proposed 10 mg/kg safety threshold is proposed to reduce the use of healthcare resources.[58] Seizures occur in 10% to 15% of intentional overdoses and typically occur within the first 6 hours after exposure. In overdoses of extended-release formulations, experts recommend an observation period of 24 hours due to the potential for delayed seizure onset. Though agitation and tremor often precede seizures, delayed seizures with no prior symptoms have been observed.[59] Other effects include hallucinations, mental status changes, agitation, and arrhythmias.[60][36] The treating clinician should rule out the presence of coingestants. Bupropion misuse is rare but has been reported.[61] Management of Overdose Seizures should be treated with intravenous benzodiazepines. Bupropion and hydroxybupropion are highly lipid-soluble, and intravenous lipid emulsion therapy can help treat bupropion overdose.[62] Successful use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been documented in patients with severe cardiotoxicity associated with bupropion overdose.[63] Please see StatPearls companion topic "Bupropion Toxicity" for an in-depth discussion regarding bupropion toxicity.

Physicians and nurse practitioners frequently prescribe bupropion. However, all healthcare workers who prescribe this agent must be familiar with its associated adverse effects, which occur in at least 10% of patients. The most severe adverse effects include a lowered seizure threshold and the potential worsening of suicidal ideation. Clinicians should perform a mental health assessment of patients at each visit and educate them on what to do if and when a seizure develops.[64] Pharmacists and nurses should also participate in these monitoring activities, perform medication reconciliation before drug administration, and inform the rest of the team of any concerns. This type of collaboration and communication can lead to more successful outcomes with bupropion therapy. An interprofessional team approach and communication among clinicians, pharmacists, and nurses are crucial to decreasing potential adverse effects and improving patient outcomes related to bupropion therapy.