Single dose bupropion related acute dystonia: a case report

Bupropion is an important pharmacologic agent similar to nicotine in the treatment of smoking cessation approved by Food and Drug Administration and European Union. Also, bupropion is an agent in the treatment of major depression as noradrenaline and dopamine reuptake inhibitor. In nicotine addiction, it is thought that it affects by blocking the dopamine reward pathway and decreasing the withdrawal symptoms related with noradrenaline pathway. We aimed to present a case with major depression and nicotine addiction developing acute dystonia with use of bupropion. Thirty-two year-old male, was diagnosed as having major depression and comorbid nicotine addiction. He did not have either another psychiatric problems or another medical disease and also he had not been using any kind of medicine. He was started to have 300 mg/day bupropion. The day after having first dose of 300 mg bupropion, he had some kind of pseudoesthesias which caused sense of his neck being shorten, holding his tongue out of his mouth, and not swallowing his saliva so he was taken to emergency. Evaluations and routine testing were observed normal ranges and there were not determined any pathologic issues out of acute dystonia during the neurologic examination. Clinical table showed that acute dystonia related to bupropion. His symptoms were getting better after he was given 5 mg biperiden as i.m. Finally, it was observed that there were not any dystonia symptoms after 24 hours of his check. Side effects of bupropion include insomnia, headache, dry mouth, eruption, nausea, excessive sweating, tinnitus and hypertension. Psychiatric problems including hypomania, acute psychosis, visual hallucinations and dystonia, hyponatremia, hypokalemia, and thrombotic thrombocytopenic purpura also reported as side effects of bupropion use in literature.