What are the cardiac side effects of bupropion (Wellbutrin)?

From the Guidelines

Bupropion can cause several cardiac side effects, including increased heart rate, palpitations, and hypertension, and patients with pre-existing cardiovascular disease should use it with caution and under close medical supervision. The most common cardiac side effects of bupropion include tachycardia, palpitations, and hypertension, as noted in studies such as 1. More serious but less common cardiac effects include arrhythmias, chest pain, and in rare cases, myocardial infarction.

Key Considerations

• Bupropion works by inhibiting the reuptake of norepinephrine and dopamine, which can stimulate the sympathetic nervous system and lead to these cardiovascular effects.
• Patients with a history of seizures or eating disorders should not use bupropion due to its ability to lower seizure threshold, which can indirectly affect cardiac function during seizure events.
• Blood pressure and heart rate should be monitored regularly, especially when starting treatment or adjusting dosage.
• If a patient experiences severe chest pain, irregular heartbeat, or significant increases in blood pressure while taking bupropion, they should seek immediate medical attention.

Monitoring and Precautions

• Vital signs should be monitored in patients treated with bupropion, as recommended in 1.
• Bupropion should be avoided in patients with uncontrolled hypertension or those treated with, or within 14 days of, monoamine oxidase inhibitors.
• While there are no long-term cardiovascular outcome data for bupropion, recent meta-analyses do not show an elevated risk of serious adverse cardiovascular effects, as noted in 1.

Conclusion Not Applicable - Direct Answer Only

The most recent and highest quality study 1 suggests that bupropion can cause cardiac side effects, and patients should be monitored accordingly.

From the FDA Drug Label

Although most patients recovered without sequelae, deaths associated with overdoses of bupropion alone have been reported in patients ingesting large doses of the drug Multiple uncontrolled seizures, bradycardia, cardiac failure, and cardiac arrest prior to death were reported in these patients. Other serious reactions reported with overdoses of bupropion alone included ... sinus tachycardia, ECG changes such as conduction disturbances or arrhythmias ...

The cardiac side effects of bupropion include:

• Cardiac failure
• Cardiac arrest
• Bradycardia
• Sinus tachycardia
• ECG changes such as conduction disturbances or arrhythmias 2 2

From the Research

Bupropion Cardiac Side Effects

• Bupropion is relatively free of cardiac side effects in depressed patients without cardiac disease 3
• However, in patients with preexisting heart disease, bupropion may cause:
  • A rise in supine blood pressure 3
  • Exacerbation of baseline hypertension in some patients 3
  • Tachycardia, which can be a predictor of adverse outcomes, including seizures, hypotension, and dysrhythmias 4
  • Ventricular dysrhythmias, cardiogenic shock, and death in cases of bupropion toxicity 5
• Factors associated with adverse cardiovascular events in bupropion exposures include:
  • Age 5
  • Seizures, particularly complicated seizures 5
  • QRS widening 5
  • QTc prolongation 5
• Bupropion may be a safe alternative to other antidepressants, such as imipramine, in depressed patients with congestive heart failure, as it does not cause severe orthostatic hypotension or adversely affect ejection fraction 6
• The cardiovascular profile of bupropion may make it a useful agent in the treatment of depressed patients with preexisting cardiovascular disease, but further studies are needed to confirm these findings 3, 7