Can Wellbutrin Cause Increased Blood Pressure?
Yes, bupropion (Wellbutrin) can cause elevated blood pressure and hypertension, and blood pressure monitoring is required during treatment. 1
FDA-Mandated Warnings and Monitoring
The FDA drug label explicitly states that treatment with bupropion can result in elevated blood pressure and hypertension. 1 Blood pressure must be assessed before initiating treatment and monitored periodically during therapy. 1
Key Clinical Data from FDA Label
- In seasonal affective disorder trials, 2% of bupropion-treated patients (11/537) developed hypertension versus 0% on placebo (0/511), with 2 patients discontinuing due to hypertension. 1
- Mean systolic blood pressure increased by 1.3 mmHg in the bupropion group versus 0.1 mmHg in placebo (statistically significant, p=0.013). 1
- Mean diastolic blood pressure increased by 0.8 mmHg in the bupropion group versus 0.1 mmHg in placebo. 1
- When combined with nicotine replacement therapy, 6.1% of patients developed treatment-emergent hypertension compared to 2.5% with bupropion alone. 1
Guideline Recommendations for Monitoring
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. 2 The American Gastroenterological Association recommends avoiding naltrexone-bupropion ER in patients with uncontrolled hypertension. 3, 2
Risk Factors for Hypertension with Bupropion
The risk of hypertension is substantially increased when bupropion is used concomitantly with: 1
- MAO inhibitors
- Other drugs that increase dopaminergic or noradrenergic activity
- Nicotine replacement therapy (particularly nicotine patches)
Clinical Trial Evidence
Patients with Mild Hypertension
A randomized, double-blind, placebo-controlled trial in 300 community volunteers with untreated stage 1 hypertension found that bupropion SR 300 mg/day resulted in less reduction in systolic blood pressure compared to placebo (-4.20 vs -6.53 mmHg; p=0.020). 4 Heart rate increases were small but statistically significant at 400 mg/day versus placebo (2.28 vs -0.64 beats/min; p=0.004). 4
Patients with Cardiovascular Disease
In a study of 36 depressed inpatients with preexisting heart disease, bupropion caused a rise in supine blood pressure, and treatment was discontinued in 14% of patients due to adverse effects, including exacerbation of baseline hypertension in 2 patients. 5 However, bupropion had a low rate of orthostatic hypotension compared to tricyclic antidepressants. 5
Comparison to Other Antidepressants
According to the 2020 International Society of Hypertension guidelines, different antidepressant classes have varying effects on blood pressure: 3
- SNRIs (serotonin-norepinephrine reuptake inhibitors): 2/1 mmHg increase
- Tricyclic antidepressants: Increased odds ratio of 3.19 for hypertension
- SSRIs (selective serotonin reuptake inhibitors): No increases in blood pressure
A comprehensive review confirms that bupropion, as a dopamine-norepinephrine reuptake inhibitor, can lead to blood pressure increases, usually at high doses. 6
Clinical Pitfalls and Practical Considerations
Common pitfall: Failing to monitor blood pressure in the first 12 weeks of treatment when hypertensive effects are most likely to manifest. 2
Important caveat: While bupropion can cause hypertension, it paradoxically has a lower risk of orthostatic hypotension compared to tricyclic antidepressants, making it potentially safer in patients prone to postural blood pressure drops. 7, 5, 8
Dose-dependent effect: The hypertensive effect appears dose-related, with higher doses (≥300 mg/day) showing more pronounced effects. 1, 4