Can Wellbutrin XL Lead to Chest Pain? (3+ studies mentioned)

This article will explore the potential association between Wellbutrin XL and chest pain. It is important to understand the possible risks and factors that may contribute to chest pain while taking Wellbutrin. The article will also discuss the research findings surrounding this topic, as well as provide recommendations for proper administration and precautions to minimize potential adverse effects.

Ultimately, it is crucial to consult healthcare professionals for personalized advice and prompt medical attention if any symptoms like chest pain or shortness of breath occur. 

Can Wellbutrin XL lead to chest pain?

Wellbutrin XL may lead to chest pain. While only a small fraction of the studies found an association between bupropion use and chest pain, the exact mechanism and causal relationship remain unclear.

Most of the studies that investigated this did not find chest pain to be a direct side effect of bupropion. In fact, it was declared that bupropion is one of the safest antidepressants in case of preexisting heart diseases.

Moreover, it is essential to consider individual patient factors and the potential interaction between bupropion and other medications when assessing the risk of adverse effects. Some individuals are at higher risk of experiencing chest pain while taking Wellbutrin than others.

Various reasons may contribute to this variability, including age, dose, gender, other medications, co-morbidities and diseases, lifestyle, etc. Thus, it is essential to contact your healthcare provider as soon as you suffer from any symptoms like chest pain or shortness of breath. Your doctor may identify any underlying causes or make adjustments to your treatment plan.

What does research suggest?

There is one case report in 2001 linking bupropion to acute coronary syndrome, where a patient experienced symptoms like chest pain, diaphoresis, and shortness of breath. However, as it was found that this man had also taken another sympathomimetic agent, pseudoephedrine, researchers concluded that the acute coronary syndrome and chest pain were a result of the additive sympathetic effect of both drugs rather than a side effect of bupropion [1].

In another study, other adverse effects were reported by patients taking bupropion, including pain upon breathing, rapid heart rate or palpitations, and increased sweating. This same study stated that patients with cardiovascular disease who received bupropion did not experience changes in heart rate or blood pressure compared to baseline [2]. 

The data suggests that chest complaints are more likely to occur following the recommended dose increase after 3 days of use, and reducing the dose was found to solve this problem. It was also reported that withdrawal of bupropion totally stopped the chest pain. However, this study stated that the origin of the chest pain remains unclear, and it is unlikely to be caused by heart disease [2].

Overall, research states that bupropion appears to have a wider safety margin and may be safer than other tricyclic antidepressants in patients prone to orthostatic hypotension or cardiac conduction disorders [3]. It was also stated in another study that it be a useful treatment option for depressed patients with preexisting cardiovascular disease. However, further studies with larger sample sizes and longer treatment durations are needed to confirm these findings [4].

Overall, it can be concluded that Wellbutrin-associated chest pain is not a common side effect and is subject to individual variability. Treatment adjustments like dose reduction or discontinuation can sometimes solve this problem. A lot of factors like age, underlying conditions, medications, and lifestyle can affect the risk of someone suffering from chest pain while administering Wellbutrin.

What can you do to avoid Wellbutrin XL-induced chest pain?

Dose reduction was found to reduce chest pain associated with bupropion therapy. In some cases, discontinuation of the drug can be the solution [2]. Here are some strategies to minimize the occurrence of chest pain as a side effect while taking Wellbutrin, as well as suggestions for managing it if it occurs:

Consult with your healthcare professional

It is crucial to have an open and honest discussion with your healthcare professional. They can provide you with valuable insights into the dosage escalation process specific to your condition and guide you through the potential side effects and how to mitigate them effectively. 

If you experience chest pain while taking Wellbutrin, consult with your healthcare professional regarding its management. They may recommend medication or further diagnostic tests to identify the underlying cause, provide support, and guide you through the appropriate treatment plan.

Implement a slow titration schedule

A common strategy is to begin with a low dose and gradually increase it over several weeks. This method assists in minimizing side effects as your body acclimates to the medication. Administering a high dose right away puts people at a much higher risk for side effects like chest pain, especially if they already have a cardiac or respiratory disease.

For instance, your healthcare professional may recommend starting with 150 mg once a day for the first week, followed by 300 mg once a day for the second week, and so on [5].

Take the medication as prescribed

Ensuring regular and consistent dosing of Wellbutrin is crucial. Do not skip doses or make any changes without consulting your healthcare professional. Maintaining a stable blood concentration of the medication may help to reduce the likelihood of chest pain.

Wellbutrin XL tablets must be swallowed whole without chewing or crushing as these actions will release the entire active drug right away and cause an overdose. Moreover, it is recommended to take the tablets at the same time every day to maintain stable concentrations of the drug in the body. 

Consider treatment adjustment

Doctors may consider adjusting the treatment as part of the management strategy. This can include modifying the dosing schedule, switching to a different strength of the medication, or exploring different brands or alternative formulations like sustained-release bupropion (Wellbutrin IR).

Reduce the dose

If chest pain occurs as a side effect of Wellbutrin XL, a doctor may recommend reducing the dosage. Lowering the dose can help minimize the intensity or frequency of the chest pain. The specific dosage reduction will depend on the individual and may involve decreasing the daily dose or adjusting the frequency of administration. 

Switch to another medication

In some cases like bupropion allergy or persistent chest pain, a doctor may consider discontinuing Wellbutrin XL. You must not discontinue the drug abruptly, as this may lead to withdrawal symptoms. In this event, healthcare professionals may explore alternative antidepressant options that are less likely to cause chest pain.

Alternatives may include Selective Serotonin Reuptake Inhibitors (SSRIs) like citalopram, Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), or atypical antidepressants. The selection will depend on the patient’s specific needs, medical history, allergies, current medications, and response to previous treatments.

What factors can influence Wellbutrin-related chest pain?

Various factors can affect one’s risk of experiencing chest pain as a side effect of Wellbutrin’s. It is important to note that chest pain can be a symptom of various medical conditions, as well as it can be a potential side effect of some medications.

Here are some of the medications that may increase the chance of feeling chest pain, especially while taking bupropion:

  • Antibiotics like azithromycin and clarithromycin
  • Antidepressants, particularly tricyclic antidepressants like amitriptyline and selective serotonin reuptake inhibitors (SSRIs) like sertraline
  • Amphotericin B
  • Antimalarials like Chloroquine and Hydroxychloroquine
  • Clozapine
  • Antimigraine medications (Ergotamine and Methysergide)
  • All stimulants and most sympathomimetics (amphetamine, dextroamphetamine, methylphenidate, methamphetamine, and pseudoephedrine)
  • Benzodiazepines such as diazepam or alprazolam

Furthermore, Patients who are suffering from the conditions mentioned below are at more risk of experiencing chest pain while administering Wellbutrin:

  • Angina
  • Heart attack
  • Gastroesophageal reflux disease (GERD)
  • Costochondritis
  • Pulmonary embolism
  • Anxiety and Panic attack
  • Respiratory conditions (like Pneumonia, bronchitis, asthma, or chronic obstructive pulmonary disease (COPD))


In conclusion, Wellbutrin XL may potentially lead to chest pain, although studies have yielded varied results and the exact mechanism and causal relationship remain unclear. Individual factors such as age, co-morbidities, medications, and lifestyle can influence the risk of experiencing chest pain while taking Wellbutrin.

It is crucial to promptly contact a healthcare provider if any symptoms like chest pain, allergic reaction, or shortness of breath occur, as they can evaluate the situation and make necessary adjustments to the treatment plan. Proper administration of Wellbutrin XL, adherence to dose escalations, and consideration of potential interactions with other medications are important to minimize risks. It is always recommended to consult healthcare professionals for personalized advice.


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Pederson KJ, Kuntz DH, Garbe GJ. Acute myocardial ischemia associated with ingestion of bupropion and pseudoephedrine in a 21-year-old man. Can J Cardiol. 2001 May;17(5):599-601. PMID: 11381283.


de Graaf L, Diemont WL. Chest pain during use of bupropion as an aid in smoking cessation. Br J Clin Pharmacol. 2003 Oct;56(4):451-2. doi: 10.1046/j.1365-2125.2003.01890.x. PMID: 12968991; PMCID: PMC1884381.


Wenger TL, Stern WC. The cardiovascular profile of bupropion. J Clin Psychiatry. 1983 May;44(5 Pt 2):176-82. PMID: 6406453.


Roose SP, Dalack GW, Glassman AH, Woodring S, Walsh BT, Giardina EG. Cardiovascular effects of bupropion in depressed patients with heart disease. Am J Psychiatry. 1991 Apr;148(4):512-6. doi: 10.1176/ajp.148.4.512. PMID: 1900980.


WELLBUTRIN XL® (bupropion hydrochloride extended-release tablets). Full prescribing information”. United States Food and Drug Administration (FDA). Available from:

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