Can bupropion (Bupropion) SR (Sustained Release) cause hypertension?

Bupropion SR Can Cause Elevated Blood Pressure

Yes, bupropion SR can cause elevated blood pressure and should be avoided in patients with uncontrolled hypertension. 1 The FDA drug label specifically warns that treatment with bupropion can result in elevated blood pressure and hypertension, requiring blood pressure assessment before initiating treatment and periodic monitoring during therapy.

Mechanism and Evidence

Bupropion is a dopamine/norepinephrine reuptake inhibitor that affects the sympathetic nervous system, which can lead to blood pressure changes. The FDA label indicates:

• Bupropion can cause a rise in supine blood pressure 1
• The risk of hypertension increases when bupropion is used with other medications that increase dopaminergic or noradrenergic activity 1
• Clinical trials have shown significant elevations in blood pressure with bupropion use 1

Clinical Research Findings

Research studies have demonstrated bupropion's effects on blood pressure:

• A randomized, double-blind, placebo-controlled study in individuals with mild untreated hypertension found that while all groups showed decreases in blood pressure, the reduction in systolic blood pressure was less with bupropion SR 300 mg/day compared to placebo (difference of 2.33 mmHg, p=0.020) 2

• In patients with cardiovascular disease, bupropion caused a rise in supine blood pressure and led to treatment discontinuation in 14% of patients, including two cases of exacerbation of baseline hypertension 3

• Another study comparing bupropion to nortriptyline found small but statistically significant increases in supine diastolic blood pressure of 5.6 mmHg on day 7 and 7.5 mmHg on day 28 with bupropion treatment 4

Risk Factors and Monitoring

Certain factors increase the risk of bupropion-induced hypertension:

• Concomitant use with monoamine oxidase inhibitors (MAOIs) 1
• Combination with nicotine replacement therapy (6.1% incidence of treatment-emergent hypertension) 1
• Pre-existing hypertension 1
• High doses (particularly above 300 mg/day) 5

Clinical Recommendations

1. Before starting bupropion SR:

   • Assess baseline blood pressure
   • Evaluate for pre-existing cardiovascular conditions
   • Review concomitant medications that may interact

2. During treatment:

   • Monitor blood pressure periodically
   • Be particularly vigilant during the first few weeks of treatment
   • Consider more frequent monitoring in patients with pre-existing hypertension

3. Contraindications:

   • Uncontrolled hypertension 6
   • Active or unstable coronary disease 6

Special Considerations

• When used for smoking cessation, bupropion SR has been reported to have no clinically significant effect on mean blood pressure in some studies, including those with hypertensive patients 7

• In obesity management, naltrexone/bupropion should be avoided in patients with uncontrolled hypertension 6

• The risk of hypertension appears dose-related, with higher doses more likely to cause blood pressure elevation 5

Pitfalls to Avoid

• Don't overlook the need for baseline blood pressure assessment before initiating bupropion
• Don't fail to monitor blood pressure periodically during treatment
• Don't prescribe bupropion to patients with uncontrolled hypertension
• Be cautious when combining bupropion with nicotine replacement therapy, as this combination has a higher incidence of treatment-emergent hypertension
• Don't ignore patient reports of headaches, dizziness, or other symptoms that might indicate elevated blood pressure

In conclusion, while bupropion SR is an effective medication for depression and smoking cessation, its potential to cause elevated blood pressure requires careful patient selection and monitoring.