What is a suitable medication for managing binge eating disorder in a patient currently taking retatrutide?

Medication Management for Binge Eating Disorder in Patients on Retatrutide

Direct Answer

Lisdexamfetamine (50-70 mg/day) is the recommended first-line medication for binge eating disorder and can be safely combined with retatrutide, as there are no known contraindications between these agents. 1, 2, 3, 4

FDA-Approved Treatment

• Lisdexamfetamine is the only FDA-approved medication specifically for moderate-to-severe binge eating disorder and should be the first pharmacologic choice when medication is indicated 3, 4, 5
• The medication demonstrated significant efficacy in reducing binge eating days per week, with placebo-subtracted differences of -1.35 and -1.66 binge days per week in two pivotal trials 4
• Dosing follows a titration protocol: start at 30 mg/day for 1 week, then increase to 50 mg/day, with further titration to 70 mg/day as tolerated and clinically indicated 4
• The most recent high-quality evidence (2025) shows combined CBT plus lisdexamfetamine achieved 70.2% remission rates, significantly superior to either treatment alone 6

Compatibility with Retatrutide

• Retatrutide is a novel GLP-1/GIP/glucagon receptor agonist that has been reported to reduce binge eating in individuals with obesity or overweight 7
• There are no documented drug interactions or contraindications between lisdexamfetamine and retatrutide 7
• The combination may be particularly beneficial as lisdexamfetamine addresses the core psychopathology of binge eating (impulsivity, compulsivity) while retatrutide provides metabolic benefits 7, 8

Alternative Medication Options (If Lisdexamfetamine Contraindicated)

• Topiramate has substantial evidence for reducing binge eating behaviors, often used as phentermine/topiramate ER combination therapy 1, 2
• Naltrexone/Bupropion (Contrave) is particularly useful for patients with food cravings or addictive eating patterns, and may benefit those with comorbid depression 1, 2, 3

Critical Contraindications for Lisdexamfetamine

• Absolute contraindications include: current or recent (within 14 days) MAOI use, linezolid treatment, or intravenous methylene blue 4
• Cardiovascular cautions: avoid in patients with serious heart disease, heart defects, or uncontrolled hypertension; sudden death has occurred in patients with structural cardiac abnormalities 4
• Psychiatric monitoring required: can precipitate new or worsening psychotic symptoms, mania, or bipolar illness 4

Medications to Avoid

• Mirtazapine and tricyclic antidepressants should be avoided in BED patients with obesity due to significant weight gain potential 1, 2, 3, 7
• Atypical antipsychotics (olanzapine, clozapine) and valproate should also be avoided where possible due to metabolic adverse effects 7

Monitoring Protocol

• Initial assessment monthly for the first 3 months, then at least every 3 months thereafter 3
• Monitor blood pressure and heart rate regularly during lisdexamfetamine treatment 4
• Discontinuation criteria: if <5% weight loss at 12 weeks, consider alternative medication or treatment approaches 3

Treatment Algorithm

1. First-line: Lisdexamfetamine 50-70 mg/day (after titration from 30 mg/day) 3, 4
2. If cardiovascular contraindications exist: Consider topiramate or naltrexone/bupropion 1, 2
3. If significant food cravings predominate: Naltrexone/bupropion may be preferred 1, 2
4. If comorbid obesity is primary concern: Consider topiramate-containing regimens or continue retatrutide alongside BED-specific medication 1, 2
5. Optimal approach: Combine lisdexamfetamine with cognitive-behavioral therapy for superior outcomes (70.2% remission vs. 40-45% with monotherapy) 6

Important Clinical Pearls

• Lisdexamfetamine is a Schedule II controlled substance with abuse potential; assess risk for substance misuse before prescribing 4
• Most treatment-emergent adverse events (dry mouth, headache, insomnia) are mild to moderate and rarely lead to discontinuation 5
• The American Psychiatric Association recommends psychotherapy (CBT or interpersonal therapy) as initial treatment, with medication added if preferred by patient or if psychotherapy alone is insufficient after 6 weeks 9, 1