What is the relationship between Bupropion (Wellbutrin) and chest pain?

From the Guidelines

If you're experiencing chest pain while taking Wellbutrin, stop taking the medication and seek emergency medical care right away. Chest pain is a potentially serious side effect of Wellbutrin (bupropion) that requires immediate medical attention, as it could indicate a cardiovascular side effect, which though rare, can be dangerous 1. Wellbutrin affects neurotransmitters like dopamine and norepinephrine, which can sometimes impact heart rate and blood pressure in certain individuals. Some key points to consider when taking Wellbutrin include:

• This medication has been associated with cardiovascular effects in some patients, particularly those with pre-existing heart conditions 1.
• Other concerning symptoms to watch for include irregular heartbeat, severe headache, difficulty breathing, or feeling faint.
• Never restart Wellbutrin after experiencing chest pain without explicit approval from your healthcare provider.
• Your doctor may need to switch you to an alternative antidepressant that has a different mechanism of action and side effect profile. Some important considerations when taking Wellbutrin are:
• Always inform your healthcare providers about all medications you're taking and any history of heart problems before starting Wellbutrin.
• Be aware of the potential for serious side effects, including chest pain, and seek medical attention immediately if you experience any concerning symptoms 1.

From the FDA Drug Label

Instruct patients to discontinue bupropion hydrochloride extended-release tablets (XL) and consult a healthcare provider if they develop an allergic or anaphylactoid/anaphylactic reaction (e.g., skin rash, pruritus, hives, chest pain, edema, and shortness of breath) during treatment.

Chest pain is listed as a symptom of an allergic or anaphylactoid/anaphylactic reaction to bupropion hydrochloride extended-release tablets (XL) 2.

• Patients should be instructed to discontinue the medication and consult a healthcare provider if they experience chest pain or any other symptoms of an allergic reaction.
• It is essential to monitor patients for any adverse reactions, including chest pain, and to provide guidance on when to seek medical attention 2.

From the Research

Wellbutrin and Chest Pain

• Wellbutrin, also known as bupropion, is an antidepressant medication that has been studied for its cardiovascular effects in patients with and without preexisting heart disease 3, 4, 5.
• A study published in 1991 found that bupropion did not cause significant conduction complications, did not exacerbate ventricular arrhythmias, and had a low rate of orthostatic hypotension in patients with preexisting left ventricular impairment, ventricular arrhythmias, and/or conduction disease 3.
• However, another study published in 2023 found that bupropion toxicity can cause cardiogenic shock, ventricular dysrhythmias, and death, and that increasing age, seizures, QRS widening, and QTc prolongation were associated with adverse cardiovascular events in bupropion exposures 6.
• In terms of chest pain specifically, there is limited information available in the provided studies.
• A study published in 1987 compared the cardiovascular effects of imipramine and bupropion in depressed patients with congestive heart failure, and found that neither drug adversely affected ejection fraction or other indices of left ventricular function, but that imipramine caused severe orthostatic hypotension in 50% of patients, while bupropion did not 4.
• Another study published in 2004 found that bupropion and paroxetine had different effects on cardiovascular and neuroendocrine responses to stress in depressed patients, with bupropion associated with increased total peripheral resistance and plasma norepinephrine, and reduced heart rate variability 7.

Cardiovascular Effects of Bupropion

• The cardiovascular profile of bupropion has been assessed in several studies, and has been found to be relatively safe in patients with and without preexisting heart disease 3, 4, 5.
• Bupropion has been found to have a low incidence of cardiovascular complaints, and does not appear to adversely affect supine or standing blood pressure, or cause orthostatic hypotension 5.
• However, bupropion has been found to be associated with an increased risk of adverse cardiovascular events, including cardiogenic shock, ventricular dysrhythmias, and death, particularly in patients with preexisting heart disease or those who take large amounts of the drug 6.