Bupropion is an antidepressant mainly used now for nicotine suppression. It comes as an extended release preparation 150 mg in Australian and New Zealand. In overdose it can cause seizures and cardiotoxicity however, good supportive care usually prevents any adverse outcome.
Valproic acid (sodium valproate) in overdose results in CNS depression and large overdoses can result in multi-system organ failure and death. Chronic toxicity can cause life threatening hyperammonia and hepatotoxicity.
Monoamine Oxidase inhibitors (MAOIs) come in different varieties and there is a little more to remember than just the interaction with cheese. The irreversible non-selective (MAO-A+B) are notorious for causing lethal serotonin toxicity in overdose, these include Phenelzine and Tranylcypromine.
Phenytoin intoxication can occur either with repeated supra therapeutic dosing or an acute overdose. Dose-dependent CNS depression occurs. Most presentations are benign and have good outcomes with supportive care. The main risk to patients is falling which can last days.
Overdose with newer anticonvulsant agents include: Gabapentin, Lamotrigine, Levetiracetam, Oxcarbazepine, Pregabalin, Tiagabine, Topiramate and Vigabatrin.
We discuss the management of benzodiazepine overdose including zopiclone and zolpidem as which carefully selected cases to use flumazenil. Benzodiazepines are a frequent presentation either as a single ingesting or in combination. With good supportive care prognosis is excellent.
Carbamazepine overdose has a predictable dose-dependent CNS depression and anticholinergic effects. Carbamazepine if unique in the anticonvulsants that is also has sodium channel blocking effects and can act similarly in overdose to a tricyclic antidepressant and the role of sodium bicarbonate should be remembered.
Over anticoagulation is a common problem with warfarin and acute intoxication maybe in those with or without an anticoagulation requirement. This can make the approach to treatment difficult when considering the need for therapeutic anticoagulation and expert advice maybe required.