From the FDA Drug Label
Although most patients recovered without sequelae, deaths associated with overdoses of bupropion alone have been reported in patients ingesting large doses of the drug Multiple uncontrolled seizures, bradycardia, cardiac failure, and cardiac arrest prior to death were reported in these patients.
Bupropion is associated with bradycardia in the context of overdose, as reported in the drug label 1 and 1. This suggests that while bradycardia is not a commonly expected side effect of bupropion at therapeutic doses, it can occur in severe overdose situations. Key points to consider include:
- Overdose context: Bradycardia has been reported in cases of bupropion overdose.
- Severity: This condition can be severe and is associated with other serious cardiac complications.
- Clinical management: In cases of overdose, supportive care and close medical supervision are crucial.
From the Research
Bupropion is rarely associated with bradycardia, but it can occur in certain situations, such as massive overdose or in combination with other medications like metoprolol, as reported in a case study published in 2004 2. In general, bupropion is more commonly associated with tachycardia (increased heart rate) rather than bradycardia (slowed heart rate) due to its mechanism of action as an atypical antidepressant, which involves inhibiting the reuptake of dopamine and norepinephrine, leading to mild stimulant-like effects. The cardiovascular effects of bupropion typically include potential increases in blood pressure and heart rate in some patients. However, in cases of massive overdose, bupropion can cause paradoxical cardiac effects, including sinus bradycardia, as observed in a case report published in 2016 3. Additionally, bupropion can interact with other medications, such as beta-blockers like metoprolol, to increase the risk of bradycardia, as described in a case study published in 2004 2. When prescribing bupropion, healthcare providers should be aware of these potential interactions and monitor patients closely, especially those with pre-existing cardiovascular conditions. Some key points to consider when prescribing bupropion include:
- Starting at lower doses (such as 150 mg daily of the extended-release formulation) and gradually increasing to therapeutic doses (usually 300 mg daily, sometimes up to 450 mg daily) to minimize side effects
- Monitoring patients with pre-existing cardiovascular conditions more closely
- Being aware of potential drug-drug interactions, such as with metoprolol
- Educating patients to contact their healthcare provider promptly if they experience significant heart rate or blood pressure changes while on bupropion.