Bupropion Overdose Resulted in a Pharmacobezoar in a Fatal Bupropion (Wellbutrin®) Sustained‐release Overdose: Postmortem Distribution of Bupropion and its Major Metabolites |
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| Authors: | Gregory Schmit MD Evy De Boosere MD Jessica Vanhaebost MD Arnaud Capron PhD |
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| Affiliation: | 1. Department of Pathology, Cliniques Universitaires St Luc, Brussels, Belgium;2. Morphology Reasearch Group, Institute for Experimental and Clinical Reasearch, Université Catholique de Louvain, Brussels, Belgium;3. Centre of Forensic Medicine, Cliniques Universitaires St Luc, Brussels, Belgium;4. Department of Forensic Medicine, Antwerp University Hospital, Edegem, Belgium;5. Louvain Centre for Toxicology and Applied Pharmacology, Université Catholique de Louvain, Brussels, Belgium;6. Clinical Chemistry Department, Cliniques Universitaires St Luc, Brussels, Belgium |
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| Abstract: | Bupropion (BUP) overdose commonly causes generalized seizures and central nervous system depression. The case of a 28‐year‐old woman who died from a massive lethal overdose with sustained‐release bupropion (Wellbutrin® 300 mg) is herein presented. The autopsy revealed the presence of a pharmacobezoar consisting of at least 40 tablets in the stomach. Determination of bupropion and its active metabolites (hydroxybupropion, threobupropion, erythrobupropion) was achieved by a liquid chromatographic mass spectrometry (LC‐MS/MS) method. Postmortem concentrations for bupropion, hydroxybupropion, threobupropion, and erythrobupropion were obtained in intracranial blood, urine, bile, liver, kidney, and vitreous humor. In this case, intracranial blood level of the parent drug was 1.9 mg/L. Threobupropion was the most abundant metabolite in both blood and urine, 59.3 and 890.6 mg/L. Tissue distribution showed the highest concentration in the liver, 12.3 mg/kg. The 0.8 bupropion concentration ratio vitreous/blood suggested that vitreous could be a valuable specimen for toxicological analysis should postmortem blood be unavailable. |
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| Keywords: | forensic science bupropion overdose postmortem tissue concentrations toxicology |
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