What medications are used to treat bulimia?

Medications for Bulimia Nervosa Treatment

Fluoxetine (Prozac) at a dosage of 60 mg daily is the first-line medication treatment for bulimia nervosa, as it is FDA-approved specifically for this condition and has demonstrated efficacy in reducing binge-eating and purging behaviors. 1

First-Line Pharmacotherapy

Fluoxetine (FDA-Approved)

• Dosage: 60 mg daily
• Indication: Moderate to severe bulimia nervosa (at least 3 bulimic episodes per week for 6 months)
• Evidence: Established in 8-16 week clinical trials 1
• Efficacy: Significantly reduces binge-eating and vomiting episodes compared to placebo 2
• Maintenance: Has demonstrated efficacy in maintaining response for up to 52 weeks in patients who initially responded to treatment 1

Alternative Medication Options

For patients who do not respond to or cannot tolerate fluoxetine, other options include:

Other SSRIs

• Sertraline: 100 mg/day has shown efficacy in reducing binge-eating crises and purging behaviors 3
• May be considered when fluoxetine is not tolerated

Medications for Binge Eating Behaviors

When binge eating is a predominant feature:

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

Treatment Algorithm

1. Initial Treatment: Start with fluoxetine 60 mg daily
2. Assessment: Evaluate response after 8-12 weeks
   • If good response: Continue treatment and periodically reevaluate long-term usefulness
   • If inadequate response: Consider alternative SSRI (sertraline) or adjunctive therapy
3. Treatment-Resistant Cases: Consider:
   • Switching to another antidepressant
   • Adding cognitive behavioral therapy (CBT) if not already implemented
   • Combination approaches with other medications based on symptom profile

Important Clinical Considerations

• Monitoring: Regular assessment of bulimic behaviors (binge eating, purging), weight, vital signs, and mood symptoms
• Duration: While acute efficacy has been established in 8-16 week trials, long-term treatment may be necessary with periodic reevaluation 1
• Combination Treatment: Adding medication to psychological treatment (particularly CBT) provides greater improvement than either treatment alone 5
• Treatment Failures: Fluoxetine may be beneficial for patients who have not responded to or have relapsed following psychological treatments 6

Potential Pitfalls and Cautions

• Side Effects: Common adverse events with fluoxetine include insomnia, nausea, asthenia, and tremor 2
• Dosing: The 60 mg/day dosage of fluoxetine shows more robust effects than lower dosages for bulimia nervosa 2
• Comprehensive Approach: Medication should ideally be part of a multidisciplinary treatment plan that includes psychological interventions, particularly CBT 4, 5
• Monitoring: Regular assessment of eating behaviors and symptoms is necessary throughout treatment 4

Remember that while medication can be effective, combining pharmacotherapy with psychological interventions (particularly CBT) typically produces better outcomes than medication alone in the treatment of bulimia nervosa 5.