The cardiovascular effects of bupropion and nortriptyline in depressed outpatients.
The cardiovascular effects of bupropion hydrochloride and nortriptyline were compared in a double-blind, randomized, 6-week trial in adult outpatients with major depression. After a 1-week placebo phase, 58 patients were randomized to treatment with bupropion (225-450 mg/day) and 57 to nortriptyline (75-150 mg/day). Nortriptyline-treated patients had statistically significant heart rate increases at each assessment as determined by RR intervals on electrocardiogram (14.5-18 bpm). Bupropion-treated patients had small but statistically significant increases in supine diastolic blood pressure of 5.6 mm Hg on day 7 and 7.5 mm Hg on day 28. A few patients in each treatment group had orthostatic changes, but only nortriptyline-treated patients had symptomatic orthostatic hypotension. A slowing of cardiac conduction and possibly of rate-corrected repolarization occurred in patients treated with nortriptyline that did not occur in patients treated with bupropion. Compared to nortriptyline, bupropion appears to have a wider safety margin with regard to cardiovascular effects. This may be particularly true in the elderly, in patients with preexisting cardiovascular disease, or in overdose.
Kiev
A
A
Social Psychiatry Research Institute, New York, New York.
Masco
H L
HL
Wenger
T L
TL
Johnston
J A
JA
Batey
S R
SR
Holloman
L C
LC
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D016642:Bupropion / Q000009:adverse effects* / Q000627:therapeutic use; D002319:Cardiovascular System / Q000187:drug effects; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D007024:Hypotension, Orthostatic / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000009:adverse effects* / Q000627:therapeutic use
D016642:Bupropion; D009661:Nortriptyline