Will cardiac side effects of bupropion (bupropion) improve over time in a patient experiencing heart palpitations but otherwise feeling well?

From the Guidelines

Bupropion-induced heart palpitations may not necessarily improve over time, and patients experiencing this side effect should seek medical evaluation rather than waiting for potential resolution. When considering the management of heart palpitations in patients on bupropion, it's crucial to weigh the benefits of continued treatment against the potential risks, particularly given the lack of long-term cardiovascular outcome data for naltrexone-bupropion ER, as noted in the 2022 guideline on pharmacological interventions for adults with obesity 1. The guideline highlights the importance of monitoring vital signs in patients treated with naltrexone-bupropion ER and advises against its use in patients with uncontrolled hypertension, underscoring the need for cautious management of cardiovascular side effects 1. Key considerations for patients experiencing heart palpitations on bupropion include:

• The potential for bupropion to lower the seizure threshold and its implications for patients with a history of seizures or epilepsy 1
• The necessity of monitoring for neuropsychiatric adverse effects, including suicidal thoughts and behaviors, especially in younger individuals 1
• The importance of avoiding sudden discontinuation of bupropion to prevent withdrawal symptoms Given these factors, medical evaluation is essential to determine the best course of action, which may include adjusting the dose, switching formulations, or discontinuing bupropion under medical supervision.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Cardiac Side Effects of Bupropion

• The cardiac side effects of bupropion, such as heart palpitations, may be a concern for some patients 2, 3, 4, 5, 6.
• Studies have shown that bupropion is relatively safe in terms of cardiac side effects, with a low incidence of significant conduction complications, orthostatic hypotension, and exacerbation of ventricular arrhythmias 3, 4.
• However, some patients may experience increased heart rate, supine blood pressure, and subjective cardiovascular complaints while taking bupropion 3, 4.
• In patients with preexisting heart disease, bupropion may be a useful treatment option due to its relatively favorable cardiovascular profile 3.
• The risk of cardiotoxicity associated with bupropion overdose is relatively low, but can occur, particularly with elevated serum concentrations of bupropion 5.
• Minor symptoms such as tachycardia/palpitations may be harbingers of more severe effects, and patients who experience these symptoms should be closely monitored 6.

Improvement of Cardiac Side Effects Over Time

• There is limited evidence to suggest that cardiac side effects of bupropion improve over time in patients who experience heart palpitations but otherwise feel well 2, 3, 4, 5, 6.
• One study found that cardiotoxicity associated with bupropion overdose appeared to be caused primarily by the parent drug, and that serum levels of bupropion peaked with the onset of cardiotoxicity and fell into the therapeutic range within 24 hours 5.
• Another study found that outcomes from single unintentional ingestions of bupropion in adults were overall mild and appeared to be dose-related, with home management being an option for doses up to 900 mg in an appropriate patient population 6.
• However, more research is needed to fully understand the relationship between bupropion use and cardiac side effects, and to determine whether these side effects improve over time in patients who experience them 2, 3, 4, 5, 6.