Seizure Diagnosis and Management

Medication-Related Seizure Risk

• The American College of Neurology recommends discontinuing bupropion immediately and permanently after a seizure has occurred, as it is absolutely contraindicated, with a dose-dependent seizure risk of approximately 0.1% at doses up to 300 mg/day 1, 2
• Bupropion accounts for a significant portion of drug-induced seizures, with rates of seizure occurrence even at therapeutic doses, and the seizure risk is dose-dependent 1, 2

Endocrine Considerations

• The Endocrine Society notes that medications are among the most common causes of hyperprolactinemia through dopamine antagonism, and hypothyroidism causes hyperprolactinemia in 40% of men and 36% of women with frank primary hypothyroidism 3
• Chronic kidney disease causes hyperprolactinemia in 30-65% of patients due to increased secretion and reduced renal clearance, according to the National Kidney Foundation 3

Alternative Treatment Options

• The American Psychiatric Association recommends switching to an alternative antidepressant without seizure risk, such as an SSRI, mirtazapine, or vortioxetine, after a seizure has occurred while on bupropion 2