Wellbutrin (Bupropion) and Hypertension

Yes, Wellbutrin (bupropion) can cause elevated blood pressure and hypertension. 1

Mechanism and Risk

Bupropion treatment can result in elevated blood pressure and hypertension, as explicitly stated in the FDA drug label 1
The risk of hypertension is increased if bupropion is used concomitantly with MAOIs or other drugs that increase dopaminergic or noradrenergic activity 1
Bupropion can cause small but statistically significant increases in supine diastolic blood pressure (5.6-7.5 mmHg) 2
The hypertensive effect appears to be dose-related, with higher doses more likely to cause blood pressure elevation 1, 3

In a study of patients with heart disease and depression, bupropion treatment was discontinued in 14% of patients due to adverse effects, including exacerbation of baseline hypertension in two patients 4
In a randomized, double-blind, placebo-controlled study of individuals with mild untreated hypertension, bupropion SR 300 mg/day showed less reduction in systolic blood pressure compared to placebo (-4.20 vs -6.53 mmHg) 3
Mean heart rate increases were small but statistically significant at 400 mg/day versus placebo (2.28 vs -0.64 beats/min) 3
In seasonal affective disorder trials, hypertension was reported as an adverse reaction in 2% of the bupropion group compared to none in the placebo group 1

Blood pressure should be assessed before initiating treatment with bupropion and monitored periodically during treatment 1
More careful monitoring is recommended in patients who receive the combination of bupropion and nicotine replacement therapy, as this combination shows a higher incidence of treatment-emergent hypertension 1
For patients taking naltrexone-bupropion ER for weight management, blood pressure and heart rate should be monitored periodically, especially in the first 12 weeks of treatment 5

Bupropion should be used with caution in patients with preexisting hypertension 1, 4
Patients with cardiovascular disease may be at higher risk for blood pressure effects 4, 2
Naltrexone-bupropion ER (used for weight management) should be avoided in patients with uncontrolled hypertension 5
Compared to tricyclic antidepressants, bupropion appears to have a wider safety margin with regard to cardiovascular effects, particularly in the elderly and in patients with preexisting cardiovascular disease 2

While bupropion can cause hypertension, it may also rarely cause orthostatic hypotension, especially in patients with cardiovascular diseases 6
Some studies have shown that bupropion may be a safer alternative for patients who developed orthostatic hypotension on tricyclic antidepressants 7

When prescribing bupropion, carefully consider the patient's baseline blood pressure status and cardiovascular comorbidities 6
Start with lower doses and titrate gradually to minimize the risk of hypertension 1
If significant blood pressure elevation occurs, consider dose reduction or discontinuation of bupropion 1, 4
For patients with preexisting hypertension, ensure blood pressure is well-controlled before initiating bupropion and monitor more frequently during treatment 1, 6