From the FDA Drug Label
The risk of hypertension is increased if bupropion hydrochloride extended-release tablets (XL) are used concomitantly with MAOIs or other drugs that increase dopaminergic or noradrenergic activity [see Contraindications (4)] There are no controlled studies assessing the safety of bupropion in patients with a recent history of myocardial infarction or unstable cardiac disease. In a clinical trial of bupropion immediate-release in MDD subjects with stable congestive heart failure (CHF) (N=36), bupropion was associated with an exacerbation of pre-existing hypertension in 2 subjects, leading to discontinuation of bupropion treatment
The FDA drug label does not answer the question about patients with a history of heart block taking Wellbutrin (bupropion) 1.
From the Research
Patients with a history of heart block should generally avoid taking Wellbutrin (bupropion) due to the potential risk of worsening cardiac conduction abnormalities. This recommendation is based on the mechanism of action of bupropion, which inhibits the reuptake of norepinephrine and dopamine, potentially affecting heart rhythm and electrical conduction 2. Although a study from 1991 found that bupropion did not cause significant conduction complications in patients with preexisting heart disease, including conduction disease 2, more recent and higher-quality evidence is needed to confirm this finding. A 2022 meta-analysis found that antidepressants, including bupropion, were associated with an increased risk of atrial fibrillation, but not ventricular arrhythmias or sudden cardiac death 3. However, this study did not specifically examine the risk of bupropion in patients with a history of heart block. Given the potential risks, alternative medications such as selective serotonin reuptake inhibitors (SSRIs) may be safer options for patients with heart block who require treatment for depression or smoking cessation. Any patient with a history of heart block who is considering antidepressant therapy should have a thorough cardiac evaluation before starting medication and discuss all potential risks and alternatives with both their cardiologist and psychiatrist to determine the safest treatment approach. Key considerations for treatment include:
- Thorough cardiac evaluation before starting medication
- Discussion of potential risks and alternatives with cardiologist and psychiatrist
- Consideration of alternative medications, such as SSRIs
- Monitoring for cardiac conduction abnormalities and other potential side effects.