Wellbutrin Causes Modest Increases in Blood Pressure and Heart Rate
Wellbutrin (bupropion) typically increases systolic blood pressure by approximately 1-6 mmHg, diastolic blood pressure by approximately 1-8 mmHg, and heart rate by approximately 3-7 beats per minute. These are average increases observed across multiple studies, though individual responses vary 1, 2.
Specific Cardiovascular Effects
Blood Pressure Changes
The FDA label for Wellbutrin XL reports mean increases from clinical trials in seasonal affective disorder of:
- Systolic BP: +1.3 mmHg (statistically significant, p=0.013)
- Diastolic BP: +0.8 mmHg (not statistically significant, p=0.075) 1
However, other studies show more variable effects:
- In adults with ADHD, bupropion increased systolic BP by +5.9 mmHg (p<0.05) 2
- In depressed outpatients, bupropion increased supine diastolic BP by +5.6 mmHg at day 7 and +7.5 mmHg at day 28 3
- In patients with cardiac disease, bupropion caused a rise in supine blood pressure, though specific values weren't detailed 4
- In individuals with mild untreated hypertension, the reduction in systolic BP was 2.33 mmHg less than placebo (suggesting a relative increase) 5
Heart Rate Changes
Heart rate increases are consistently documented:
- +6.9 bpm in adults with ADHD (p<0.05) 2
- +2.92 bpm at 400 mg/day dose versus placebo (p=0.004) 5
- +3.71 bpm in a meta-analysis of amphetamine-like drugs 6
- Prolonged administration studies show sustained increases in heart rate 7
Notably, one study found no significant effect on pulse rate in patients with preexisting heart disease 4, and another found no change in heart rate in depressed outpatients 3, suggesting individual variability.
Clinical Implications and Monitoring
Who Is at Higher Risk
Blood pressure and heart rate should be monitored periodically while taking naltrexone-bupropion ER, especially in the first 12 weeks of treatment 8. The 2022 AGA guidelines specifically note this requirement for the combination product used in obesity management.
The 2016 AACE/ACE guidelines state that naltrexone ER/bupropion ER should be avoided if other weight-loss medications can be used because weight loss assisted by this combination cannot be expected to reduce blood pressure, and the drug is contraindicated in uncontrolled hypertension 9.
Treatment-Emergent Hypertension
- Approximately 2% of patients developed hypertension as an adverse reaction in SAD trials 1
- When combined with nicotine replacement therapy, 6.1% developed treatment-emergent hypertension versus 2.5% with bupropion alone 1
- In patients with preexisting cardiac disease, 14% discontinued treatment due to adverse effects, including exacerbation of baseline hypertension in 2 patients 4
Monitoring Protocol
Based on FDA labeling and clinical guidelines:
- Assess blood pressure before initiating treatment 1
- Monitor periodically during treatment, with particular attention in the first 12 weeks 8
- Monitor blood pressure and heart rate when combining with nicotine replacement therapy 1
- Consider more frequent monitoring in patients with:
- Preexisting hypertension
- Cardiovascular disease
- Concurrent use of MAOIs or other dopaminergic/noradrenergic drugs
Important Caveats
The cardiovascular effects are dose-dependent and generally modest but statistically significant. While the average increases are small (1-8 mmHg for BP, 3-7 bpm for heart rate), individual patients may experience larger changes. The risk of hypertension is increased when bupropion is used with MAOIs or other drugs that increase dopaminergic or noradrenergic activity 1.
In patients with established cardiovascular disease, guidelines recommend using bupropion with caution and careful monitoring of heart rate and blood pressure, continuing only if weight-loss goals are met 9.