From the Research
Wellbutrin (bupropion) is not absolutely contraindicated in patients with dysautonomia, but it should be used with caution in this population. Patients with dysautonomia may be more sensitive to the side effects of Wellbutrin, particularly those related to cardiovascular function such as increased blood pressure, tachycardia, and palpitations 1. When considering Wellbutrin for a patient with dysautonomia, it's advisable to start at a lower dose (such as 75mg once daily) and titrate slowly while monitoring for autonomic symptoms. Close monitoring of blood pressure, heart rate, and orthostatic changes is recommended during initiation and dose adjustments. The medication's norepinephrine-dopamine reuptake inhibition mechanism can potentially exacerbate autonomic nervous system instability in some patients. However, individual responses vary significantly, and some patients with dysautonomia may tolerate the medication well.
Some key points to consider when using Wellbutrin in patients with dysautonomia include:
- The potential for increased heart rate and blood pressure, which can be problematic in patients with postural orthostatic tachycardia syndrome (POTS) or other forms of dysautonomia 2
- The importance of careful dose titration and monitoring for autonomic symptoms, such as lightheadedness, headache, and sleep disturbances 3
- The need for a thorough risk-benefit assessment, considering the severity of the patient's dysautonomia, their specific autonomic symptoms, and the indication for Wellbutrin treatment.
Alternative antidepressants with less impact on the autonomic nervous system might be preferable first-line options for patients with significant dysautonomia. It's essential to weigh the potential benefits of Wellbutrin against the potential risks and to consider individual patient factors, such as the severity of their dysautonomia and their specific symptoms 4, 5.