What should I do if I experience chest pain, palpitations, dizziness, and sweating while taking Wellbutrin (bupropion)?

Immediate Action Required: Stop Wellbutrin and Seek Emergency Evaluation

If you are experiencing chest pain, palpitations, dizziness, and sweating while taking Wellbutrin (bupropion), you should discontinue the medication immediately and seek urgent medical evaluation, as these symptoms may represent serious cardiovascular or hypersensitivity reactions that require immediate assessment. 1

Why These Symptoms Are Concerning

These symptoms collectively suggest potential serious adverse reactions:

• Chest pain and palpitations are recognized cardiovascular adverse effects of bupropion that occurred at rates twice that of placebo in clinical trials at 400 mg/day dosing 1
• Sweating is a common adverse reaction occurring in at least 5% of patients at rates twice that of placebo 1
• Dizziness similarly occurred at rates exceeding placebo in controlled trials 1
• The combination of these symptoms may indicate hypersensitivity reactions, which the FDA specifically warns can include chest pain, edema, and shortness of breath requiring immediate discontinuation 1

Immediate Steps to Take

Call 911 or go to the emergency department immediately if:

• Chest pain is severe, crushing, or radiating to your arm or jaw 2
• You have shortness of breath accompanying the chest pain 2
• You develop skin rash, hives, or swelling along with these symptoms (suggesting anaphylaxis) 1
• You feel like you might pass out or lose consciousness 2

Contact your prescribing physician urgently (same day) if:

• Symptoms are mild but persistent
• You can safely reach medical care without emergency services
• You need guidance on medication discontinuation

What Your Healthcare Provider Will Assess

Your medical evaluation should focus on:

• Cardiac evaluation: ECG to assess for arrhythmias, QTc prolongation, or ischemic changes, as ventricular arrhythmias can present with palpitations, chest pain, dizziness, and sweating 2
• Blood pressure measurement: Both supine and standing, as bupropion can cause hypertension (which may manifest as chest pain, palpitations, and sweating) 1, 3
• Hypersensitivity assessment: Examination for rash, urticaria, angioedema, or other allergic manifestations, as anaphylactoid reactions to bupropion can present with chest pain and require immediate discontinuation 1
• Medication history: Review of all current medications, as bupropion can interact with other drugs and the combination may lower seizure threshold or cause cardiovascular effects 4

Why Bupropion Causes These Effects

Bupropion's mechanism explains these cardiovascular symptoms:

• Norepinephrine and dopamine reuptake inhibition can increase sympathetic tone, leading to tachycardia, palpitations, hypertension, and sweating 5, 6
• Cardiovascular adverse events including heart palpitations and chest pain occurred significantly more frequently than placebo in large systematic reviews (RR 1.81, though major cardiovascular events were not significantly increased) 2
• In patients with preexisting heart disease, bupropion caused supine blood pressure elevation and was discontinued in 14% due to adverse effects including hypertension exacerbation 3

Common Pitfalls to Avoid

Do not assume these are "just anxiety" - while bupropion can cause agitation and anxiety 1, the combination of chest pain, palpitations, dizziness, and sweating warrants cardiac evaluation to rule out serious arrhythmias or ischemia 2

Do not continue the medication while "waiting to see if it improves" - the FDA label specifically instructs patients to discontinue bupropion and consult a healthcare provider if they develop chest pain during treatment 1

Do not abruptly restart bupropion after these symptoms without medical clearance - rechallenge should only occur after thorough cardiovascular evaluation and discussion of risks versus benefits 1

Alternative Considerations

If bupropion must be discontinued due to these adverse effects:

• Other antidepressants with different mechanisms (SSRIs, SNRIs, mirtazapine) may be better tolerated if depression treatment is needed 2, 5
• Cardiovascular workup should be completed before starting any alternative antidepressant, as some symptoms may indicate underlying cardiac disease rather than drug effect 2
• Gradual dose reduction over 10-14 days is recommended when discontinuing antidepressants to limit withdrawal symptoms, though in the setting of serious adverse reactions, immediate discontinuation takes priority 2