How to prevent arrhythmia due to bupropion (Wellbutrin)

From the Guidelines

To avoid an arrhythmia due to bupropion, it is crucial to follow the recommended dosing guidelines, start with a low dose, and inform your healthcare provider about any history of seizures, eating disorders, heart problems, or head trauma, as these increase arrhythmia risk, as noted in the 2022 study 1. When taking bupropion, it is essential to be aware of the potential risks and take steps to minimize them.

• Start with a low dose, typically 150 mg once daily for 3-7 days before increasing to the target dose if needed.
• Do not exceed the maximum recommended dose of 450 mg per day, and for sustained-release formulations, maintain at least 8 hours between doses.
• Inform your healthcare provider about any history of seizures, eating disorders, heart problems, or head trauma, as these increase arrhythmia risk.
• Avoid alcohol and stimulants while taking bupropion, and do not abruptly stop the medication.
• Stay well-hydrated and maintain electrolyte balance, particularly potassium and magnesium levels. Bupropion can cause arrhythmias because it affects norepinephrine and dopamine levels, which influence heart rhythm, and has a dose-dependent risk of seizures that can trigger cardiac events, as mentioned in the 2009 study 2. If you experience palpitations, dizziness, fainting, or chest pain while taking bupropion, seek immediate medical attention as these may indicate an arrhythmia. It is also important to note that bupropion may be associated with an increased risk for seizures, as indicated in the 2008 study 3, and that the long-term cardiovascular safety of naltrexone-bupropion ER remains unclear, as stated in the 2022 study 1. Therefore, it is vital to closely monitor your condition and adjust your treatment plan accordingly to minimize the risk of arrhythmia and other potential side effects.

From the FDA Drug Label

The following additional adverse reactions occurred in controlled trials of bupropion HCl immediate-release (300 to 600 mg per day) at an incidence of at least 1% more frequently than in the placebo group were: cardiac arrhythmia (5% vs. 4%)

To avoid an arrhythmia due to bupropion, monitoring of cardiac function is recommended, especially in patients with pre-existing heart conditions.

• Dose adjustment may be necessary to minimize the risk of arrhythmia.
• Regular check-ups with a healthcare provider can help identify any potential cardiac issues early on.
• Patients should be aware of the symptoms of arrhythmia, such as palpitations, shortness of breath, or dizziness, and seek medical attention immediately if they occur 4.

From the Research

Avoiding Arrhythmia due to Bupropion

To minimize the risk of arrhythmia when taking bupropion, consider the following:

• Bupropion is generally considered to be 10 to 100 times less likely to induce cardiac conduction problems than tricyclic drugs 5.
• In patients with preexisting heart disease, bupropion did not cause significant conduction complications, did not exacerbate ventricular arrhythmias, and had a low rate of orthostatic hypotension 6.
• However, bupropion treatment was discontinued for 14% of patients due to adverse effects, including exacerbation of baseline hypertension 6.
• Massive bupropion overdose can lead to ECG conduction delays and intraventricular conduction disturbances 7.
• Clinical and electrocardiographic factors associated with adverse cardiovascular events in bupropion exposures include age, seizures, QRS widening, and QTc prolongation 8.

Monitoring and Precautions

• Cardiac monitoring should be considered in patients taking bupropion, especially in those with preexisting heart disease or at risk of seizures 6, 7.
• Patients should be monitored for signs of arrhythmia, such as changes in pulse or blood pressure, and ECG should be performed regularly 6, 8.
• Bupropion dosage should be maintained at 450 mg/day or less in a divided schedule to minimize the risk of seizures and arrhythmia 5.

Special Considerations

• Antidepressant use, including bupropion, may be associated with an increased risk of atrial fibrillation, but this risk may be due to confounding by indication rather than a direct effect of the medication 9.
• Patients with a history of arrhythmia or cardiac disease should be closely monitored while taking bupropion, and alternative treatments should be considered if necessary 6, 8.