How much does Wellbutrin (bupropion) increase blood pressure on average?

Wellbutrin's Effect on Blood Pressure

Wellbutrin (bupropion) typically increases systolic blood pressure by 2-4 mmHg and diastolic blood pressure by 2-3 mmHg on average. 1

Mechanism and Evidence

• Bupropion can elevate blood pressure through its effects on dopaminergic and noradrenergic activity, which can increase sympathetic nervous system activation 1
• According to the FDA drug label, treatment with bupropion extended-release tablets can result in elevated blood pressure and hypertension, requiring blood pressure assessment before initiating treatment and periodic monitoring during treatment 1
• In clinical trials for seasonal affective disorder, bupropion treatment was associated with a mean increase in systolic blood pressure of 1.3 mmHg compared to 0.1 mmHg with placebo (p=0.013) 1
• The mean increase in diastolic blood pressure was 0.8 mmHg in the bupropion group versus 0.1 mmHg in the placebo group, though this difference was not statistically significant (p=0.075) 1

Dose-Dependent Effects

• In a randomized, double-blind, placebo-controlled study of individuals with untreated mild hypertension, bupropion SR at 300 mg/day showed less reduction in systolic blood pressure compared to placebo (-4.20 vs -6.53 mmHg, respectively; Δ = 2.33, P = 0.020) 2
• The International Society of Hypertension guidelines classify bupropion among antidepressants that can increase blood pressure, noting that selective norepinephrine and serotonin reuptake inhibitors (SNRIs) can increase blood pressure by approximately 2/1 mmHg 3

Patient-Specific Considerations

• The effect of bupropion on blood pressure can be highly variable between individuals, with greater increases noted in:
  • Elderly patients
  • Those with higher baseline blood pressure
  • Patients using antihypertensive therapy
  • Individuals with kidney disease 3
• In patients with preexisting cardiovascular disease, bupropion caused a rise in supine blood pressure, with treatment discontinued in 14% of patients due to adverse effects, including exacerbation of baseline hypertension in some patients 4
• A comparative study showed that bupropion-treated patients had small but statistically significant increases in supine diastolic blood pressure of 5.6 mmHg on day 7 and 7.5 mmHg on day 28 5

Monitoring Recommendations

• Blood pressure should be assessed before initiating treatment with bupropion and monitored periodically during treatment 1
• The risk of hypertension is increased if bupropion is used concomitantly with MAOIs or other drugs that increase dopaminergic or noradrenergic activity 1
• Particular caution is needed when combining bupropion with nicotine replacement therapy, as this combination showed a higher incidence of treatment-emergent hypertension (6.1%) compared to bupropion alone (2.5%) 1

Clinical Implications

• Bupropion may be preferable to tricyclic antidepressants in patients with orthostatic hypotension, as it does not typically cause this side effect 6, 7
• However, bupropion can eliminate weight loss-induced benefits on blood pressure that might otherwise be expected with successful depression treatment 3
• For patients with uncontrolled hypertension, a history of coronary artery disease, congestive heart failure, cardiac arrhythmias, or stroke, bupropion should be used with caution or avoided 1