Bupropion is contraindicated in a patient being evaluated for an eating disorder even though her body mass index is currently normal. The specific reason is:

• A It causes severe hypokalemia through renal potassium wasting
• B It precipitates serotonin syndrome when combined with nutritional supplements
• C It lowers the seizure threshold and purging behavior increases this risk further ✓
• D It causes dose-dependent QT prolongation aggravated by electrolyte shifts

Explanation

Bupropion is a norepinephrine-dopamine reuptake inhibitor with no serotonergic action, ruling out serotonin syndrome (option B). Its major dose-related toxicity is seizures, occurring in up to 0.4% of patients on immediate-release formulations above 450 mg/day. It is contraindicated in eating disorders because vomiting and laxative abuse from purging cause dehydration and electrolyte disturbance that markedly amplify seizure risk. It also lacks QT liability, making options A and D incorrect.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

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Written and medically reviewed by the StethoPrep medical team.