Anticholinergic symptoms in a patient with a bupropion overdose successfully managed with physostigmine: a case report

We report the case of anticholinergic poisoning in a patient suffering from an overdose of bupropion. The patient presented with bilateral mydriasis, involuntary movements and signs of agitation. Bupropion is commonly used as antidepressant and smoking cessation aid. It inhibits neuronal reuptake of dopamine and norepinephrine and also antagonizes acetylcholine at the level of the nicotinic receptor sites. So far bupropion overdose resulting in symptoms mimicking an anticholinergic syndrome has rarely been reported in literature. In this case, one milligram of intravenous physostigmine, an acetylcholinesterase inhibitor, rapidly resolved patient agitation and mydriasis. This case indicates that physostigmine might be used as an antidote to quickly reverse the central and peripheral anticholinergic symptoms in patients with an overdose of bupropion.