Is dizziness and tachycardia a reason to stop taking bupropion (Wellbutrin)?

Dizziness and Tachycardia: When to Stop Bupropion

Yes, dizziness and racing heart (tachycardia) are significant side effects that may warrant discontinuation of bupropion, especially if severe or persistent. These symptoms can indicate cardiovascular effects that require medical attention and potential medication adjustment.

Understanding Bupropion's Cardiovascular Side Effects

• Bupropion commonly causes cardiovascular effects including tachycardia (racing heart), and neurological effects such as dizziness 1
• These side effects are well-documented and recognized as part of bupropion's safety profile 2, 1
• Cardiovascular effects can range from mild to severe, with tachyarrhythmias specifically listed among the known adverse effects 2

When to Stop Bupropion Due to Cardiovascular Effects

Immediate Discontinuation Warranted:

• If experiencing severe dizziness that affects daily functioning or safety 1, 3
• If tachycardia is pronounced, persistent, or accompanied by other cardiac symptoms 1, 4
• If symptoms suggest more serious cardiovascular involvement (hypotension, syncope, chest pain) 5, 4

Monitoring vs. Discontinuation:

• Mild, transient dizziness or slight heart rate increases that resolve within the first few weeks may be monitored rather than requiring immediate discontinuation 1
• Blood pressure and heart rate should be monitored periodically while taking bupropion, especially during the first 12 weeks of treatment 2

Risk Factors That Increase Concern

• Pre-existing cardiovascular disease increases risk of adverse events 1
• Uncontrolled hypertension is a contraindication for continued bupropion use 1
• Older age is associated with increased risk of adverse cardiovascular events from bupropion 4
• Concomitant medications that may interact with bupropion or independently affect heart rate 1

Clinical Implications and Management

• Cardiovascular side effects from bupropion appear to be dose-related; higher doses correlate with increased risk 6
• QRS widening and QTc prolongation on ECG are independently associated with adverse cardiovascular events in bupropion users 4
• Patients experiencing dizziness and tachycardia should be evaluated for possible ECG changes 4
• In one study, patients who developed serious adverse events often first presented with symptoms like being "jittery"/anxious/agitated (83% of cases) 6

Special Considerations

• Bupropion should be used with caution in patients with cardiovascular disease 1
• The combination of naltrexone and bupropion (used for weight management) carries specific warnings about monitoring blood pressure and heart rate 2
• Bupropion overdose can cause severe cardiotoxicity including sinus tachycardia with prolonged QTc and QRS intervals 5
• There have been case reports of bupropion mimicking transient ischemic attacks with symptoms including dizziness 3

Conclusion

Dizziness and tachycardia should not be dismissed as minor side effects of bupropion. While mild, transient symptoms may be monitored, persistent or severe symptoms warrant discontinuation and medical evaluation. The decision to continue or discontinue should be made in consultation with a healthcare provider who can assess the severity of symptoms and overall risk-benefit profile.