Bupropion/sertraline

Abstract

Various toxicities following overdose and drug interaction: case report A 15-year-old girl developed acute metabolic encephalopathy, generalised tonic-clonic seizures and coma following pharmacokinetic interaction between intentionally ingested sertraline and an overdose of bupropion from her mother’s medications for suicide attempt [dosages and durations of treatments to reaction onsets not stated]. The girl, who intentionally ingested her mother’s antidepressant medications including extended release bupropion and sertraline with the suicidal intent, was hospitalised for acute encephalopathy and first lifetime generalised tonic-clonic seizures. She had ingested a large quantity of extended release bupropion (overdose) and unknown amount of sertraline. She exhibited lack of brainstem reflexes. EEG revealed activity consistent with metabolic encephalopathy, which then gradually evolved to a burst suppression pattern indicating comatose state. She also had multiple myoclonic jerks in bilateral upper extremities. Sertraline delayed the metabolism of bupropion; hence increasing its concentration in the body (pharmacokinetic interaction). After 35h of initial ingestion, the girl showed rapid clinical improvement, sluggish reactive pupils, positive corneal reflexes, and consequent purposeful movement. At the time of discharge, she showed a mild anterograde amnesia (as a sequelae) during nonfocal neurological examination.