In this episode, I’ll discuss diffuse alveolar hemorrhage due to bupropion nasal inhalation.
Sympathomimetic agents like cocaine are known to cause diffuse alveolar hemorrhage when inhaled. While not considered a sympathomimetic, bupropion does have a sympathomimetic amine structure.
Authors in the journal Chest have published a case study describing Diffuse Alveolar Hemorrhage Due to Bupropion Inhalation. The case is that of a 35-year-old man with a history of anxiety, depression, and polysubstance abuse who was admitted for hypoxemic-hypercapnic respiratory failure secondary to opioid and benzodiazepine overdose.
On hospital day 12, the patient crushed and nasally inhaled his prescribed and hospital-dispensed 150 mg bupropion tablet.
The patient developed a new chest infiltrate on X-ray and progressively increasing oxygen requirements. Within 4 days he required ICU admission.
Within 5 days of snorting the bupropion, the patient developed hemoptysis and a significant drop in his hemoglobin down to 6.6 g/dL.
Treatment with methylprednisolone 40 mg q8 hours had begun 3 days after bupropion inhalation, and when the patient’s hypoxemia continued to worsen, the methylprednisolone was increased to 125 mg every 8 hours on hospital days 19 to 22. As the patient improved on hospital day 22 the methylprednisolone was tapered down to 60 mg every 12 hours, then on hospital day 24 it was decreased to 60 mg every day for 4 days, then it was discontinued.
The patient’s hypoxemia eventually resolved, and he was discharged on room air.
When assessed on the Naranjo Scale, this case scored a 6, which suggests a probable adverse drug reaction.
The authors concluded:
This case adds a novel component to bupropion-mediated toxidromes and implies that bupropion may have unelucidated local tissue-level effects in the pulmonary system, which merit further research.
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