Welcome to the internet book of prepare

podcast on bupropion poisoning.

Bupropion or wellbutrin or ill butrin.

It is the TCA overdose of our time.

So today we'll talk about the pharmacodynamics and pharmacinetics and we'll get straight

into evaluation and treatment.

So Josh, let's start off the big picture here.

Why is this such a dangerous potential poisoning?

We've all read a lot and been taught pretty thoroughly about tricyclic antidepressant poisoning,

but I have to admit that I haven't seen that a lot in practice, but what I have seen a fair

amount of is pretty severe intoxications from repropion.

And as we'll discuss, this is a uniquely dangerous antidepressant.

And with more depressed folks using it over time, I feel like this is going to emerge as a toxicologic monster.

And with the proviso for all our talks podcasts is call your friends early. We're not all toxicologists.

Our consultant friends to really help us with this. So get on the phone early and let them help guide the way.

Absolutely. And the other little disclaimer here would be that since we're intensivists, we're seeing the most severe bupropion intoxication.

So there are a lot of intoxications out there, which are relatively minor, and we're not going to linger on them too much.

So let's get straight into pharmacodynamics. So let's talk about what receptors these are working and what organ dysfunction you can see.

Yeah. So the mechanism of action of bupropion is actually inhibition of dopamine and norapinephrine

re-uptake, which is pretty interesting. So unlike most antidepressants, this has the same mechanism

of action as amphetamines, which explains why it works. And explains why a lot of the clinical

sequela you see can be just like methamphetamine

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