Prophylactic Benzodiazepine Use in Bupropion Overdose

Abstract

Objective: Patients taking bupropion are at an increased risk for suicidal ideation and often times utilize their own medications to overdose. The literature reports that seizures occur in up to 37% of bupropion overdoses. The purpose of this study is to determine if prophylactic benzodiazepine use prevents seizures in bupropion overdoses. Methods: This 5 year retrospective observational chart review analyzed patients who overdosed on bupropion between May 1, 2017 - April 30, 2022. Patients were excluded if their Arizona Poison & Drug Information Center (AZPDIC) chart was incomplete, if they never went to a healthcare facility, left AMA, had a seizure disorder or an anti-seizure coingestant. ToxSentry Query Builder was used to extract the cases. Case details were compiled into a data collection form built in Excel. Statistics were performed using an unpaired t-test in GraphPad Prism version 9.5.0. Results: 355 patients were included in this study. 95 (26.7%) patients received prophylactic benzodiazepines. Of those patients, 6 (6.3%) developed seizures. There were 260 (73.2%) patients who did not receive prophylactic benzodiazepines and 60 (23.0%) of them developed seizures. Thus, prophylactic usage of benzodiazepines in bupropion overdoses resulted in a 16.8 ± 4.6% risk reduction (p=0.0003) [0.95% CI 0.07731 to 0.2579]. Conclusion: The results of this study support the usage of prophylactic benzodiazepines to prevent seizures in patients who are suspected to have overdosed on bupropion. This is the only study to evaluate prophylaxis administration of benzodiazepines in bupropion overdoses.