No Need to Stop Bupropion Before Brain MRI for Parkinsonian Syndrome
There is no medical reason to discontinue bupropion 15 days (or any duration) before a brain MRI in a patient with Parkinsonian syndrome. MRI is a non-invasive imaging technique that does not interact with medications, and bupropion does not interfere with MRI image quality or interpretation.
Why This Confusion May Arise
The question likely stems from confusion with dopamine transporter (DAT) imaging (such as [¹²³I]FP-CIT SPECT scans), which is a completely different imaging modality from MRI. These are distinct procedures:
DAT Imaging (Not MRI)
- Bupropion, as a dopamine reuptake inhibitor, does interfere with DAT imaging by blocking dopamine transporter binding sites 1
- Standard practice recommends discontinuing bupropion at least 1 week before DAT scans 2
- However, even 1 week may be insufficient—a case report demonstrated that bupropion caused false-positive DAT imaging results even after 1 week of discontinuation, requiring 1 month of washout for accurate imaging 1
- The patient in this case had abnormal DAT scan results after 1-week discontinuation but normal results after 1-month discontinuation, with binding ratios increasing 5.2% to 31.7% across striatal regions 1
Standard Brain MRI (Your Question)
- MRI does not require any medication discontinuation for Parkinsonian syndrome evaluation 3
- MRI head without IV contrast is the appropriate initial imaging for Parkinsonian syndromes 3
- MRI evaluates structural changes, atrophy patterns, and signal abnormalities—none of which are affected by bupropion 3, 4
Clinical Context for Bupropion in Parkinsonian Syndrome
Safety Considerations
While bupropion doesn't need to be stopped for MRI, be aware of these clinical issues:
- Seizure risk: Bupropion is contraindicated in patients with seizure disorders and should be used cautiously in those at risk 2, 5
- Drug-induced Parkinsonism: Bupropion itself may rarely cause or worsen Parkinsonian symptoms through its dopaminergic effects 6, 7
- Diagnostic confusion: If DAT imaging is being considered (not MRI), longer washout periods may be necessary to avoid false-positive results 1
Potential Benefits in PD
Interestingly, bupropion may actually be beneficial for some PD patients with depression and apathy, though evidence is limited 7. The medication should not be discontinued solely for MRI purposes.
Bottom Line
Continue bupropion as prescribed and proceed with the brain MRI. If your healthcare team is planning DAT imaging (DaTscan) instead of or in addition to MRI, then discuss appropriate medication washout timing—likely requiring at least 1 month of discontinuation rather than the traditional 1-week recommendation 1.