What medications are used to treat bulimia?

Medications for Treating Bulimia Nervosa

Fluoxetine (60 mg daily) is the first-line medication treatment for bulimia nervosa, as it is FDA-approved specifically for this condition and has demonstrated significant reduction in binge-eating and purging behaviors. 1

First-Line Pharmacotherapy

• Fluoxetine (Prozac)
  • Dosage: 60 mg daily
  • FDA-approved specifically for moderate to severe bulimia nervosa
  • Efficacy established in 8-16 week clinical trials 1
  • Demonstrated significant reduction in binge-eating episodes and vomiting compared to placebo 2
  • Can maintain response for up to 52 weeks in patients who initially respond to treatment 1

Alternative Medication Options

When fluoxetine is not effective or not tolerated, consider:

1. Other SSRIs

   • Sertraline has shown efficacy in reducing binge eating crises and purging behaviors 3

2. For Binge Eating Disorder (related condition)

   • Lisdexamfetamine: FDA-approved for BED 4
   • Naltrexone/bupropion: Helpful for food cravings or addictive eating behaviors 4
   • Duloxetine: Modulates serotonergic and noradrenergic pathways involved in mood regulation and impulse control 4
   • Topiramate: Effective for BED, though optimal dosing requires further study 4

Treatment Approach

Step 1: Initiate Medication

• Begin with fluoxetine 60 mg daily (higher dose is more effective than 20 mg daily) 2
• Monitor for common side effects: insomnia, nausea, asthenia, and tremor 2

Step 2: Combine with Psychotherapy

• Cognitive Behavioral Therapy (CBT) is recommended as first-line psychological treatment 4
• The combination of medication (particularly fluoxetine) and CBT is superior to medication alone 5
• Technology-based interventions such as internet/computer-guided CBT can be useful complements to treatment 4

Step 3: Monitor and Adjust

• Assess response after 8-12 weeks of treatment
• If inadequate response to initial medication, consider switching to another agent or adding CBT if not already implemented 6
• For patients who fail to respond to psychotherapy alone, adding fluoxetine (60 mg/day) can be effective 6

Important Considerations

• Regular monitoring is essential for patients with eating disorders, including weight, nutritional status, and eating behaviors 4
• Medication should be periodically reevaluated for long-term usefulness 1
• A multidisciplinary approach involving medical, psychiatric, psychological, and nutritional expertise yields optimal outcomes 4

Common Pitfalls to Avoid

• Underestimating the severity of the eating disorder
• Focusing solely on weight rather than normalizing eating behaviors
• Inadequate monitoring for medical complications
• Not addressing underlying psychological issues
• Premature discontinuation of medication in responders

Fluoxetine remains the gold standard pharmacological treatment for bulimia nervosa with the strongest evidence base and specific FDA approval for this indication.