SHM Converge Scientific Abstract ePoster Gallery-Bupropion Toxicity Leading to Serotonin Syndrome in the Setting of Worsening Renal Disease

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This case report describes serotonin syndrome caused by bupropion toxicity in an older man with worsening chronic kidney disease. A 74-year-old male with hypertension, CKD, and depression presented with 5 days of upper abdominal pain and frequent muscle spasms. Initial evaluation for gallbladder disease was negative, but bedside exam revealed spontaneous abdominal wall contractions, ocular clonus, hyperreflexia, and bilateral lower-extremity rigidity. After reviewing his medications, clinicians found he was taking only bupropion 150 mg twice daily. Based on Hunter’s criteria, serotonin syndrome was diagnosed.<br /><br />Bupropion was stopped, and the patient was treated with diazepam and supportive care, leading to improvement. Review of prior labs showed steadily declining renal function over two years, with eGFR falling from 60 to 37. The family also reported that he had experienced severe serotonin syndrome two years earlier while taking sertraline.<br /><br />The report emphasizes that although bupropion is not classically serotonergic, it has been associated with serotonin syndrome, especially in overdose. In patients with renal impairment, bupropion clearance is significantly reduced and its half-life prolonged, which can increase drug exposure and toxicity even at standard doses. The authors highlight that worsening kidney function may require medication dose adjustment or deprescribing.<br /><br />The main takeaway is the importance of regularly reviewing medication regimens, especially in patients with chronic disease progression, to prevent adverse drug reactions.

Asset Subtitle

Jenifer Centeno Gavica

Meta Tag

Author List Jenifer Centeno Gavica, Keegan Plowman, Ricardo Franco-Sadud

Category Clinical Vignettes

Concept Serotonin Syndrome

Concept Hunter Criteria

Concept Bupropion

Concept Chronic Kidney Disease

Concept Neuromuscular Findings

Distinguished Non-Finalist

Presenter Organization NCH HealthCare System

Presenting Author Jenifer Centeno Gavica

Track Adult

Keywords

serotonin syndrome

bupropion toxicity

chronic kidney disease

renal impairment

older adult

Hunter criteria

ocular clonus

hyperreflexia

diazepam treatment

medication review

Serotonin Syndrome

Hunter Criteria

Bupropion

Chronic Kidney Disease

Neuromuscular Findings