Cardiac Side Effects of Auvelity (Dextromethorphan-Bupropion)
Auvelity carries a moderate risk of cardiovascular effects, primarily manifested as elevated blood pressure and tachycardia, with the bupropion component being the primary driver of these cardiac concerns. 1
Primary Cardiovascular Concerns
Blood Pressure Effects
- Bupropion commonly causes increases in supine blood pressure, which is the most clinically significant cardiac effect requiring monitoring. 2
- Patients with uncontrolled hypertension should avoid Auvelity entirely, as bupropion can exacerbate baseline hypertension. 3, 4
- In a study of depressed patients with preexisting heart disease, bupropion treatment was discontinued in 14% of patients due to adverse effects, including exacerbation of baseline hypertension in two patients. 2
Heart Rate and Rhythm Effects
- Tachycardia and elevated heart rate are common cardiovascular side effects that require periodic monitoring, especially during the first 12 weeks of treatment. 5, 4
- Sinus tachycardia has been reported in overdose situations, along with ECG changes including conduction disturbances and arrhythmias. 1
- Importantly, bupropion does not significantly affect pulse rate at therapeutic doses in most patients and has a low rate of orthostatic hypotension. 2
Cardiac Safety Profile in Patients with Preexisting Heart Disease
Conduction System Effects
- Bupropion does not cause significant conduction complications in patients with preexisting conduction disease, distinguishing it favorably from tricyclic antidepressants. 2
- It does not exacerbate ventricular arrhythmias in patients with baseline arrhythmias. 2
- It has no significant effect on left ventricular function in patients with preexisting left ventricular impairment. 2
Clinical Implications
- The cardiovascular profile suggests bupropion (and by extension Auvelity) may be safer than tricyclic antidepressants for depressed patients with preexisting cardiovascular disease, though caution is still warranted. 2
- The American Society of Health-System Pharmacists advises using bupropion with caution in patients with cardiovascular disease. 4
Serious Cardiac Events in Overdose
In overdose situations, severe cardiac complications can occur, including: 1
- Bradycardia
- Cardiac failure
- Cardiac arrest
- ECG changes with conduction disturbances or arrhythmias
Monitoring Recommendations
Blood pressure and heart rate should be monitored periodically while taking Auvelity, with particular attention during treatment initiation and the first 12 weeks. 5, 4
Common Non-Cardiac Side Effects for Context
While not cardiac-specific, the most common adverse effects of dextromethorphan-bupropion include dizziness, nausea, headache, diarrhea, somnolence, dry mouth, sexual dysfunction, hyperhidrosis, anxiety, constipation, decreased appetite, and insomnia. 6
Critical Contraindications
Patients with uncontrolled hypertension should not receive Auvelity due to the risk of further blood pressure elevation. 3, 4