From the Guidelines
Bupropion is not associated with an increased risk of heart failure, with recent meta-analyses showing no elevated risk of serious adverse cardiovascular effects, including heart failure, as a result of bupropion use for smoking cessation 1.
Key Points to Consider
- The risk of heart failure with bupropion is considered rare, and most patients tolerate the medication well.
- Patients with pre-existing heart conditions, particularly structural heart disease or a history of heart attacks, may be at higher risk for developing heart failure while on this medication.
- Recent systematic reviews and meta-analyses have found no significant increase in serious adverse cardiovascular events, including heart failure, with bupropion use for smoking cessation 1.
- The USPSTF recommendation statement found no difference in cardiovascular adverse events or major cardiovascular events with bupropion SR compared to placebo or no bupropion SR 1.
Important Considerations for Clinical Practice
- Monitor patients with risk factors for heart failure, such as pre-existing heart conditions, while on bupropion.
- Be aware of symptoms that could indicate heart failure, such as unusual fatigue, shortness of breath, swelling in the ankles or legs, or rapid weight gain, and advise patients to contact their healthcare provider immediately if they experience these symptoms.
- The mechanism behind bupropion-induced heart failure, if it occurs, likely relates to its norepinephrine-reuptake inhibition properties, which can increase heart rate and blood pressure in some individuals.
From the Research
Frequency of Heart Failure with Bupropion
- The frequency of heart failure with bupropion is not directly stated in the provided studies, but we can look at the cardiovascular effects of bupropion to understand its potential impact on heart health.
- A study from 1991 2 found that bupropion did not cause significant conduction complications, did not exacerbate ventricular arrhythmias, had a low rate of orthostatic hypotension, and had no effect on pulse rate in patients with preexisting heart disease.
- Another study from 2023 3 found that increasing age, seizures, QRS widening, and QTc prolongation were associated with adverse cardiovascular events in bupropion exposures, but it did not specifically mention heart failure.
- A study from 1983 4 assessed the cardiovascular profile of bupropion in over 700 depressed patients and found that bupropion did not adversely affect supine or standing blood pressure and did not cause orthostatic hypotension.
- A study from 2001 5 found no evidence of emergent depression or cardiovascular events in patients taking bupropion for smoking cessation.
- A review of antidepressants for smoking cessation from 2020 6 found high-certainty evidence that bupropion increased long-term smoking cessation rates, but it also increased the number of adverse events, including psychiatric adverse events, and there was no clear evidence to suggest whether people taking bupropion experienced more or fewer serious adverse events than those taking placebo.
Cardiovascular Effects of Bupropion
- Bupropion has been found to have a relatively safe cardiovascular profile compared to other antidepressants 2, 4.
- However, bupropion can cause adverse cardiovascular events, including vasopressor use, ventricular dysrhythmia, myocardial injury, or cardiac arrest, especially in patients with preexisting heart disease or those who take large amounts of the drug 3.
- The risk of adverse cardiovascular events with bupropion is increased in patients with certain factors, such as increasing age, seizures, QRS widening, and QTc prolongation 3.