What medications are used to treat purging disorder?

From the Guidelines

The most effective medication for purging behaviors, such as those seen in bulimia nervosa, is a serotonin reuptake inhibitor, specifically 60 mg fluoxetine daily, which should be prescribed either initially or if there is minimal or no response to psychotherapy alone by 6 weeks of treatment. This recommendation is based on the American Psychiatric Association practice guideline for the treatment of patients with eating disorders, which suggests that adults with bulimia nervosa be treated with eating disorder-focused cognitive-behavioral therapy and a serotonin reuptake inhibitor, such as fluoxetine 1. Some key points to consider when treating purging behaviors with medication include:

• The importance of combining medication with psychotherapy, particularly cognitive behavioral therapy (CBT), for best results
• The need for nutritional counseling to establish healthy eating patterns
• The potential side effects of medication, such as nausea, headache, or sleep disturbances, which typically improve within a few weeks
• The importance of medical supervision when starting these medications, as eating disorders can cause electrolyte imbalances and other health complications that may affect medication safety. In terms of specific medications, fluoxetine is the most established option, but other SSRIs like sertraline or escitalopram may also be effective 1. It's also important to note that treatment typically continues for at least 6-12 months after symptoms improve, and patients should be monitored regularly for side effects and treatment efficacy.

From the FDA Drug Label

Prozac is indicated for the treatment of binge–eating and vomiting behaviors in patients with moderate to severe bulimia nervosa The efficacy of Prozac was established in 8– to 16–week trials for adult outpatients with moderate to severe bulimia nervosa, i.e., at least 3 bulimic episodes per week for 6 months Medication for purging: Fluoxetine (Prozac) is indicated for the treatment of binge-eating and vomiting behaviors in patients with moderate to severe bulimia nervosa 2.

• The efficacy of Prozac was established in clinical trials for adult outpatients with moderate to severe bulimia nervosa.
• Prozac 60 mg/day has been shown to maintain a response in patients with bulimia who responded during an 8-week acute treatment phase.

From the Research

Medication for Purging

• Medications such as selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat purging behaviors, particularly in patients with bulimia nervosa and binge-eating disorder 3, 4.
• SSRIs have been shown to be effective in reducing binge eating and purging behaviors in the short term, and may also be effective in the long term 3, 4.
• Other medications, such as topiramate, zonisamide, and atomoxetine, may also be effective in reducing binge eating and purging behaviors, although more research is needed to confirm their efficacy 3, 4.
• Combination therapy, involving the use of multiple medications, may be required for optimal outcomes in some patients 4.
• Medical providers should be aware of the potential medical complications associated with purging behaviors, including pseudo Bartter's syndrome, and should develop a treatment plan that targets these complications 5.
• A comprehensive medical work-up, including a comprehensive metabolic panel, complete blood count, and full body exam, should be performed to identify and treat any medical complications associated with purging behaviors 6.

Treatment Strategies

• Effective medical treatment strategies for purging behaviors should include a judicious treatment plan that targets increased serum aldosterone levels and prevents severe edema formation 5.
• Medical providers should become familiar with the pathophysiology of pseudo Bartter's syndrome and the effective medical treatments that can lead to a successful outcome 5.
• The combination of pharmacological and psychological treatments is superior to single psychotherapeutic approaches or single drug treatment, and should be considered as a first-line treatment option 3.

Future Challenges

• More research is needed to improve recognition and understanding of purging disorder, particularly in terms of testing models of risk and maintenance factors to advance interventions for those who purge without binge eating 7.
• Improved interventions are needed to address the high rate of treatment failure and relapse in patients with purging disorder 7.