In this episode, I’ll discuss the chance of cardiovascular toxicity from bupropion overdose.
Bupropion overdose carries a risk of cardiovascular toxicity however the onset is often delayed. This presents an additional risk to patients if they are incorrectly presumed to be of low cardiac toxicity risk and have reduced monitoring. Traditional factors for identifying patients with bupropion overdose who are at high risk of cardiac toxicity are standard predictors as with any overdose: prior cardiac disease, initial serum bicarbonate less than 20 mEq/L, and initial QTc of at least 500 ms. A high initial lactate level has also been used to predict cardiovascular toxicity from bupropion overdose.
A group of researchers recently published in Pharmacotherapy a secondary analysis of prospective data from the Toxicology Investigators Consortium Core Registry in an attempt to better quantify the usefulness of these predictors of cardiac toxicity risk and to determine if any other risk factors could be identified.
Data from 355 patients with bupropion overdose were analyzed for risk factors that identified the development of myocardial injury, shock, ventricular dysrhythmia, or cardiac arrest.
An initial serum bicarbonate value less than 20 mEq/L, and an initial QTc of at least 500 ms both independently predicted cardiac toxicity with respective adjusted odds ratios of 4.4 and 2.5.
An initial serum lactate above 5.2 mmol/L also independently predicted cardiac toxicity with an adjusted odds ratio of 12.2. The lactate level was 90.7% specific with 80.3% negative predictive value.
The authors concluded based on how strongly serum lactate predicted cardiac toxicity that further research should be done in this area.
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