By Jan Biernacke, PGY1 Pharmacy Resident — Marshall Health Pharmacy, Huntington, WV
Bupropion (Wellbutrin, Zyban) is a dopamine and norepinephrine reuptake inhibitor and antagonizes acetylcholine at neuronal nicotinic receptors. It is commonly used as an antidepressant and smoking cessation aid. When used as prescribed, side effects may include dry mouth, nausea, agitation and insomnia.
Bupropion is not classified as a controlled substance by the DEA, but abuse has been reported, including recreational ingestion, nasal insufflation of crushed tablets, and intravenous injection. Bupropion abusers report receiving a “high” similar to cocaine abuse, but of lesser intensity.
Pharmacies in the Tri-State area (WV, OH & KY) have reported fraudulent scripts being called in under physicians who have never seen these patients. Bupropion toxicities range from skin abscesses (if injected), tremor and agitation to life-threatening seizures and cardiac toxicity. Acute management of bupropion overdose is largely supportive.
Bupropion fills are not reported to the West Virginia (Board of Pharmacy) controlled substance monitoring program at this time. Additionally, since these patients frequently obtain the medications by paying cash rather than through their insurance, it is far more challenging to identify doctor shopping, forged prescriptions, and pharmacy shopping. It is important for prescribers and pharmacists to be aware of the potential for bupropion misuse and to remain vigilant for signs of abuse and drug seeking behaviors.