The cardiovascular profile of bupropion

The cardiovascular profile of bupropion has been assessed in over 700 depressed patients. Most of the studies reviewed were double-blind comparisons with placebo or amitriptyline. Subjects included depressed adult outpatients without cardiovascular disease, elderly patients, and patients with cardiovascular disease. Increased heart rate was seen only with amitriptyline, which also caused a subclinical delay in cardiac conduction. Bupropion did not adversely affect supine or standing blood pressure, and patients with tricyclic-induced orthostatic hypotension did not show orthostasis when treated with bupropion. The incidence of subjective cardiovascular complaints with amitriptyline but not with bupropion exceeded that with placebo. Patients with cardiovascular disease who received bupropion had no change in heart rate or blood pressure compared to baseline; their incidence of cardiovascular complaints was comparable to that of disease-free controls. Finally, five patients who took large amounts of bupropion in suicide attempts showed no distinct cardiovascular abnormalities. Thus, bupropion appears safer than amitriptyline and other tricyclics in patients who are prone to orthostatic hypotension or cardiac conduction disorders, and may have a wider safety margin in overdose.