BUPROPION MISUSE BY NASAL INSUFFLATION WITH A FATAL OUTCOME: CASE REPORT AND REVIEW

Abstract

Introduction. Bupropion is the only FDA - approved synthetic cathinone, with increasing popularity in clinical practice due to its wide range of action, and lack of sexual side effects. However, its stimulant effect similar to amphetamines has growing the concern regarding its recreational use.

Aims and Methods. In this manuscript we report a case of bupropion misuse via nasal insufflation with a fatal outcome and preform a brief review of the recreational use of bupropion.

Results. We report the case of a man in his fifties, with long-term abuse of bupropion mainly via nasal insufflation, who suddenly deceased about two weeks after he was discharged for a type 2 acute myocardial infarction secondary to bupropion overdose.

Throughout the last decades, several studies have reported an increasing misuse of bupropion by non-oral routes, especially through nasal insufflation, and intravenous use, particularly in patients with a previous history of substance abuse, adolescents or in correctional settings.

Despite most patients having mild to moderate side effects, devastating consequences, such refractory seizures or refractory cardiogenic shock may occur in overdose, demanding a timely recognition and rapid approach to prevent these major outcomes.

In case of an overdose, there is no specific antidote available or curative treatment approved, its management is focused on treatment of symptoms.

Conclusions. Bupropion is an effective antidepressant, nevertheless it has a potential for recreational use, especially in high-risk groups. This paper alerts all physicians for the emerging problem involving bupropion misuse, and it adds some insights into its timely recognition and management.