OpenHealth Q&A

Concerns Regarding Possible DRESS Reaction to Bupropion

I’m a 23-year-old assigned female at birth, standing at 5 feet tall and weighing approximately 130 pounds. I don’t smoke and consume cannabis edibles occasionally (they are legal in my area). Currently, I’m on Naltrexone to manage intrusive thoughts related to self-harm (SH) and impulsive behaviors, while my doctor assists with tapering off Venlafaxine. Alongside this tapering, I started taking Buspirone and Bupropion. Last month, I had a medical emergency that led me to the emergency room. I experienced a high fever, a widespread burning rash all over my body, swelling in my ears, and a severely dry throat, nose, and chin (which began peeling days later). I felt extremely weak, nearly fainting while walking from the car and needing support from a friend. Prior to that, I endured 3 to 4 days of fever with a peak of 104.2°F, during which I couldn’t keep any food, liquids, or medications down. My knees and ankles felt precarious, and my condition deteriorated further, causing noticeable shaking and muscle twitching. My joints were painful and felt rough. The emergency staff primarily attributed my symptoms to a reaction to one of the new medications I had started, although I was also found to have some deficiencies along with significant dehydration. I was administered IV fluids, magnesium, as well as medications like Zofran, ibuprofen, and Benadryl, none of which alleviated my symptoms. My nausea persisted, the rash continued to spread, and my fever remained. Eventually, they provided me with additional treatments, including Prednisone, famotidine, and fentanyl, which I clearly remember. Blood tests indicated elevated liver enzymes (AST and ALT), and my EKG revealed a concerningly long QT interval, which alarmed the medical team. At one point, my heart rate was elevated and my blood pressure fell dangerously low, prompting fears that I might lose consciousness (which I thankfully did not). Once my vital signs stabilized, I decided against staying overnight in the hospital and was discharged with prescriptions for Prednisone, famotidine, lorazepam, and an EpiPen. In the following days, my rash gradually improved, but I developed severe dryness and peeling around my nose and lips; the area beneath my lips remained irritated for around two weeks. The dryness in my nose resulted in scabs that are still healing after a month. Interestingly, after completing the Prednisone course, I experienced a low-grade fever that fluctuated over the next week, accompanied by joint pain. I had initiated Buspirone and Bupropion about 3 or 4 weeks earlier. My doctor believed the rapid buildup of Buspirone meant it could not be the source of the reaction, and I have since resumed taking it without issues for nearly two weeks. I restarted Bupropion today and, by tonight, noticed that a subtle pink rash had emerged on my stomach, thighs, underarms, and face. Unaware of the DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) reaction previously, I am now concerned that this might have been my reaction. Though the emergency department indicated it was likely linked to new medications, they didn’t mention DRESS specifically. If I indeed experienced a DRESS reaction, is it risky to have taken another pill today, especially considering the uncertainty regarding my liver’s recovery? I am awaiting a CT scan with contrast to evaluate my liver and kidneys and to understand the origin of my irregular liver levels. I’m anxious that this irregularity could still relate to a reaction to Bupropion. Summary: I suspect I may have had a DRESS reaction to Bupropion, but due to the previous uncertainty, I was advised to restart the medication today. Now, I’m seeing a mild rash develop about 12 hours later. In the ER, the doctors believed I was having a reaction but did not specifically mention DRESS. Meanwhile, my primary care physician is investigating the elevated liver enzymes. Is it possible the high liver levels could stem from a DRESS reaction? Should I be worried about my liver’s health after taking one more dose of what is likely the cause of my symptoms?

Answers (1)

2/9/2026, 6:20:34 AM

OpenHealth AI

It's understandable to have significant concerns given your recent medical history and symptoms. Your situation highlights the complexity of medication reactions and the possibility of a serious condition like DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms).

Key Points:

• Possible DRESS Reaction: Your previous symptoms, particularly the widespread rash, fever, and liver enzyme elevations, raise concern about a serious medication reaction.
• Current Symptoms: The development of a new rash after restarting Bupropion is notable and may indicate an ongoing sensitivity or reaction to the medication.
• Liver Health: Elevated liver enzymes can be linked to several factors, including medication reactions, and it’s essential to monitor your liver function closely.

Explanation:

DRESS syndrome is a severe hypersensitivity reaction that can occur with certain medications. Symptoms can include a rash, fever, swollen lymph nodes, and multi-organ involvement (like liver dysfunction). Given your prior symptoms and the timeline of starting Bupropion, it’s crucial to approach the situation cautiously.

1. Rash & Symptoms: The appearance of a new rash after resuming Bupropion may suggest that it could still be causing a reaction. In DRESS, symptoms tend to worsen with continued exposure to the triggering agent.

2. Liver Concerns: The elevated liver enzymes you experienced can indeed result from a drug reaction, including DRESS. Continuous monitoring of your liver health is pivotal, especially after any medication changes.

Next Steps:

1. Monitor Symptoms Closely:

   • Keep track of any new or worsening symptoms, especially the rash, fever, or any additional discomfort.
   • Document your symptoms daily to share with your physician.

2. Discontinue Bupropion: Given the potential for a DRESS reaction and the new rash, it would be prudent to stop taking Bupropion. Do not take another dose until you have spoken with your healthcare provider.

3. Communicate with Your Care Team:

   • Contact your primary care physician or the prescribing doctor immediately to discuss your concerns about the rash and the potential DRESS reaction.
   • Ensure they have all the details about your recent symptoms and the medications involved.

4. Follow-Up on Liver Health:

   • Engage in the upcoming CT scan to closely evaluate liver and kidney function and discuss results and next steps regarding your liver health with your physician.

5. Emergency Plan: If you experience severe symptoms such as difficulty breathing, swelling of the face or throat, or significant changes in your health status, seek emergency medical attention right away.

Your health and safety are the priority, and ensuring clear communication with your doctors is essential to navigate this complex situation. You're not alone in this, and there are supportive steps you can take moving forward.