A 19-year-old woman with bulimia nervosa is prescribed bupropion for smoking cessation. Her psychiatrist should be warned that prescribing it is hazardous because bupropion:

• A Causes serotonin syndrome when combined with purging behaviours
• B Precipitates hypertensive crises with tyramine-containing foods
• C Produces severe hepatotoxicity in young women
• D Lowers the seizure threshold, and both bulimia and abrupt dose increases amplify this risk ✓

Explanation

Bupropion inhibits dopamine and norepinephrine reuptake and lowers the seizure threshold in a dose-dependent manner, with incidence approaching 0.4% at usual doses. Risk factors include seizure history, eating disorders such as bulimia and anorexia nervosa, and rapid titration above 450 mg/day, hence it is contraindicated here. It has no serotonergic activity, no MAO-inhibiting effect and no characteristic hepatotoxicity signal, eliminating options A, C and B.

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

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Written and medically reviewed by the StethoPrep medical team.