Can Wellbutrin 150 mg Cause Hypertension?
Yes, bupropion (Wellbutrin) 150 mg can cause hypertension, and this risk is particularly important in patients with cardiovascular disease or pre-existing hypertension. The FDA label explicitly warns that "treatment with bupropion hydrochloride extended-release tablets can result in elevated blood pressure and hypertension" 1.
Magnitude of Risk
The hypertension risk with bupropion is dose-dependent and clinically significant:
In seasonal affective disorder trials, 2% of patients on bupropion developed hypertension versus 0% on placebo, with mean systolic blood pressure increases of 1.3 mmHg (statistically significant, p=0.013) 1.
In patients with pre-existing cardiovascular disease, bupropion caused exacerbation of baseline hypertension in 2 of 36 patients (5.6%), leading to treatment discontinuation 2.
When combined with nicotine replacement therapy, the hypertension incidence jumps to 6.1% compared to 2.5% with bupropion alone 1.
Critical Monitoring Requirements
The FDA mandates that blood pressure must be assessed before initiating bupropion and monitored periodically during treatment 1. This is non-negotiable, particularly in your patient population with cardiovascular disease or risk factors.
For patients on naltrexone-bupropion combinations, blood pressure monitoring is especially critical during the first 12 weeks of treatment 3.
High-Risk Populations Requiring Extra Caution
Avoid bupropion entirely in patients with uncontrolled hypertension 3. For patients with controlled hypertension or cardiovascular disease:
Patients with congestive heart failure: In a trial of 36 CHF patients, bupropion caused hypertensive exacerbations requiring discontinuation in 2 patients 1.
Patients with coronary artery disease: Cardiovascular serious adverse reactions, including ischemic heart disease, were frequently associated with pre-existing coronary disease 4.
Younger patients: Analysis of French pharmacovigilance data showed younger patients were at significantly higher risk for serious adverse reactions 4.
Mechanism and Time Course
The hypertension risk stems from bupropion's dopaminergic and noradrenergic activity 1. The risk is substantially increased when bupropion is used with MAOIs or other drugs that increase dopaminergic or noradrenergic activity 1.
Most serious adverse reactions, including cardiovascular events, occur within a median of 12-14 days after drug initiation 4, making early monitoring essential.
Practical Clinical Approach
For patients with cardiovascular disease or hypertension:
Baseline assessment: Measure blood pressure before starting bupropion 150 mg 1.
Early monitoring: Check blood pressure within the first 2 weeks, as this is when most cardiovascular adverse events occur 4.
Ongoing surveillance: Continue periodic blood pressure monitoring throughout treatment 1.
Discontinue if hypertension develops: Two patients in cardiovascular disease trials required discontinuation due to hypertensive exacerbations 2.
Comparative Safety Context
Despite the hypertension risk, bupropion's cardiovascular profile remains favorable compared to tricyclic antidepressants. Bupropion does not cause orthostatic hypotension or cardiac conduction delays 5, 2, making it safer than tricyclics in patients prone to these complications.
In a controlled trial of patients with mild untreated hypertension, bupropion SR 300 mg/d showed only minor effects on blood pressure, though the reduction in systolic blood pressure was less than placebo (difference of 2.33 mmHg, p=0.020) 6. However, this does not exclude the possibility of treatment-emergent hypertension in individual patients 6.
Bottom Line for Your Patient
If your patient has cardiovascular disease or hypertension, bupropion 150 mg can be used but requires mandatory blood pressure monitoring before and during treatment 1. The drug should be avoided entirely if hypertension is uncontrolled 3, and discontinued if significant blood pressure elevation occurs 2.