Characteristics of dextromethorphan-bupropion exposures compared with exposures involving dextromethorphan alone or bupropion alone reported to United States poison centers

Abstract

Background Despite concerns regarding toxicity of the novel antidepressant, dextromethorphan-bupropion (DXM-BUP) in overdose, there is little information available. This study investigated characteristics of DXM-BUP exposures reported to US poison centers and compared them to those associated with bupropion alone or dextromethorphan alone.Methods We analyzed exposures involving DXM-BUP, bupropion, and dextromethorphan reported to the National Poison Data System during 2023.Results Among the 11,739 exposures in this study, 0.9% (n = 106) involved DXM-BUP. Two-thirds (67%) of DXM-BUP exposures were associated with no or minor effects or were not followed. One-third (33%) of DXM-BUP exposures were associated with serious outcomes compared with 25.4% of bupropion exposures (OR: 1.56, 95% CI: 1.02–2.34). When comparing DXM-BUP exposures to dextromethorphan exposures, there was no significant difference in serious outcomes (OR: 1.42, 95% CI: 0.92–2.14). Among DXM-BUP exposures, the most frequent related clinical effects were tachycardia (31%), confusion (13%), hypertension (12%), and agitation (10%). Compared with dextromethorphan alone, DXM-BUP exposures were more likely to be associated with seizures (OR: 8.60, 95% CI: 2.81–21.88).Conclusion Most exposures to DXM-BUP were associated with minimal effects; however, serious outcomes occurred, and more than one-fourth required inpatient hospital admission. Additional research and about the potential toxicity of DXM-BUP is needed.

Keywords

• Dextromethorphan-bupropion
• dextromethorphan
• bupropion
• National Poison Data System