Medication for Bulimia: Commonly Prescribed Medicines

Bulimia medication could be part of your recovery plan. Prescription and over-the-counter drugs can ease physical symptoms, reduce urges, and help you feel better. 

Researchers say bulimia medications are generally helpful. [1] One medication, fluoxetine, is FDA-approved for bulimia treatment. Your doctor can dip into other options if you don’t respond to this treatment.

Doctor's office

Some people take medications for a short time, while others need them longer. You’ll stay in touch with your care team to determine how long the drugs will be part of your life. 

Medications Designed for Bulimia 

The U.S. Food and Drug Administration approved one medication to help people address the binge/purge cycle of bulimia nervosa. That medication is fluoxetine (commonly sold as Prozac). It may also be prescribed for other eating disorders, such as binge eating disorder.

Prozac is an antidepressant medication known for adjusting chemical levels inside the brain. Some people with bulimia find that it helps them to control their urges and focus on therapy. 

In a study of Prozac’s efficacy, researchers found that a daily dose of about 60 mg for eight weeks was associated with a 67% reduction in binge eating and a 56% reduction in purging via vomit. [2] This is a remarkable result for medication, which is why it’s commonly used for treating eating disorders. 

60 mg of Prozac a day for eight weeks may reduce binge eating by 67% and purging by 56%. [2]

Prozac is considered a “front-line treatment” for bulimia nervosa due to its FDA approval. [3] If your team decides the medication is right for you, treatment will start with Prozac. If that doesn’t work, you can explore other options to help with binge eating disorders.

“Off-Label” Bulimia Nervosa Medication

A therapy is considered “off-label” if the medication is approved for a different condition, but your doctor prescribes it anyway. About one prescription in five fits this description, and the practice is legal. [4]

If you don’t respond to Prozac, your doctor might reach for an off-label solution that has been found to be effective for eating disorders, such as bulimia nervosa and binge eating. Many are available. 

Antidepressants 

Just like Prozac, other antidepressants can alter brain chemistry. Sometimes, people find that their urges lessen and their mood improves when taking these medications for eating disorders. Your doctor might choose the following:

  • Tricyclics like nortriptyline and amitriptyline 
  • Selective serotonin reuptake inhibitors (SSRIs) like Celexa and Lexapro 
  • Modified cyclic antidepressants like trazodone 
  • SNRIs like duloxetine 

Antidepressants have side effects; some people find them hard to use consistently. You’ll stay in close contact with your doctor. If one class of medications doesn’t help with your binge eating disorder or bulimia nervosa, another might work better. 

MAOIs

MAOIs, or monoamine oxidase inhibitors, are technically antidepressants. But they work by adjusting mood chemicals like serotonin and dopamine inside your brain. In studies published in the 1980s, researchers discovered these medications could be helpful in treating eating disorders like bulimia nervosa. 

In one study that lasted about four weeks, researchers found significant improvements in bingeing and purging behaviors. Participants said they were less likely to have binge eating urges too. [5]

Anticonvulsants 

Very small studies suggest that the prescription medication topiramate could help ease bulimia nervosa. It seems to help people stop eating to excess and binge eating, which could halt binges before they begin. But researchers say they need to study this medication more, as the studies were so small. [6]

Medications to Ease Bulimia Symptoms

The options we’ve discussed could help you control binge eating urges and purges. But what about the physical distress you might encounter during early recovery? Medications can help here too. 

Researchers say many people with eating disorders enter treatment programs with gastrointestinal (GI) problems. [7] Some fade as you get better, but medications can speed up the healing process. 

Acid Reflux 

A persistent case of heartburn may respond to simple lifestyle changes. Limiting food intake before bedtime and elevating the head of your bed could keep acids from creeping out of your stomach and into your throat. [8] 

Over-the-counter medications can also help to reduce stomach acids and keep you from burping and retching. If your lifestyle changes don’t work, your team can add these solutions to your treatment plan.

Constipation

Persistent binge eating and purging can alter your gut flora and lower hydration levels. Both can make it hard for your intestines to work correctly. Fluid therapy helps significantly, but your doctor might also use an osmotic laxative to keep stools soft and easier to pass. [8]

Since some people with bulimia nervosa use laxatives to purge, your doctor will watch your medication use closely. If you’re using it via methods your doctor doesn’t recommend, you may need a different type of treatment. 

Electrolyte Imbalances

Persistent laxative abuse combined with regular vomiting can make you deficient in nutrients like potassium and sodium. Your team can add fluids to your body via intravenous tubes while you’re in the hospital. While you’re at home, using fluids like Pedialyte could be wise.

Pain 

Your throat, teeth, and fingers may all be swollen and sore due to your bulimia nervosa. This discomfort should fade as you get better and stop vomiting.

But if your pain triggers you to return to your eating disorder, your team might recommend over-the-counter pain relievers to help. Always ask your team before using these drugs, as they can be hard on an upset stomach. 

Woman visiting doctor's office

Bulimia Nervosa Treatment: Combining Medication and Therapy

While medications can be effective to treat eating disorders and help you resist the urge to binge and purge, you must do more to recover from bulimia. Typically, your team must balance your ongoing medication with conventional talk therapy and address mental disorders. This usually includes things like cognitive behavior therapy and treating other issues (e.g., obsessive compulsive disorder, depression) simultaneously.

Ongoing Medication Management

Antidepressant medications like Prozac don’t work right away. Your brain needs time to adjust chemical levels, and your body must build a reserve of the drugs to draw upon. If your doctor recommends medications to treat eating disorder symptoms, you’ll likely stay on them for many months. 

In one study, researchers found that Prozac treatment was effective at 3, 6, and 12 months. [3] The longer some people stayed on the medication, the more likely they were to reduce binge eating, purging, and other behaviors associated with bulimia. 

Your doctor can help you understand how long you’ll take the medications, and together, you’ll create a plan for when it’s time to quit. Abruptly discontinuing some medicines can make you feel sick, so never stop without asking your doctor first. 

The Role of Therapy in the Treatment of Eating Disorders

While medications can ease chemical imbalances, they can’t change your thought patterns, opinions, and habits. All these factors play a role in your compulsion to binge and purge. Therapy can help you change that. 

Researchers say two types of therapy are proven effective in treating bulimia nervosa: [9]

  • Cognitive behavioral therapy: Adjust your thoughts about your body and learn to reduce bingeing triggers. Set realistic goals and learn how to change your life for the better.
  • Interpersonal psychotherapy. Learn to communicate effectively with friends, family, and coworkers. Find out how to address conflicts, so you’re less tempted to quell food concerns.

You might have one-on-one therapy sessions with a professional you trust. As you get better, you must attend group therapy sessions with others recovering from bulimia. 

Putting the Two Together

Psychotherapy and medications work on different parts of your bulimia. One helps to adjust imbalances, and the other helps you live a different kind of life.

Your medications may help you focus on therapy, and your therapy may help you see the value of your medicines. Ideally, these two methods will sync up and help you feel more confident. 

Should You Use Bulimia Medications?

Many people with bulimia believe they don’t need help to get better. They promise to stop bingeing and feel incredibly disappointed when they revert to old habits. 

Know that it’s challenging to recover from bulimia independently. Most people need medications, therapy, or both to get better. And there’s no shame in using available tools to help you build a better life.

If you have bulimia, talk with your doctor about your habits and what you’ve tried before to quit. Be open and honest about your challenges, and do what’s needed to improve and reduce binge eating and purging. Together, you can find a program that helps you gain control once more. 

Resources


  1. Davis, H, Attia, E. (2017). Pharmacotherapy of eating disorders. Current Opinion in Psychiatry; 30(6):452-457. 
  2. Gorla K, Mathews M. (2005). Pharmacological treatment of eating disorders. Psychiatry (Edgmont); 2(6):43-8. 
  3. Bello NT, Yeomans BL. Safety of pharmacotherapy options for bulimia nervosa and binge eating disorder. Expert Opinion in Drug Safety; 17(1):17-23. 
  4. Off-Label Drugs: What You Need to Know. (2015). Agency for Healthcare Research and Quality. Accessed August 10, 2022.
  5. Kennedy SH, Piran N, Garfinkel PE. (1985). Monoamine Oxidase Inhibitor Therapy for Anorexia Nervosa and Bulimia: A Preliminary Trial of Isocarboxazid. Journal of Clinical Psychopharmacology; 5(5):279-285.
  6. Arbaizar, B, Gómez-Acebo, I, Llorca, J. Efficacy of Topiramate in Bulimia Nervosa and Binge-Eating Disorder: A Systematic Review. General Hospital Psychiatry; 30(5):471-475.
  7. Sato, Y., Fukudo, S. (2015). Gastrointestinal symptoms and disorders in patients with eating disorders. Clinical Journal of Gastroenterology; 8, 255–263.
  8. Mehler, P.S., Krantz, M.J. & Sachs, K.V. (2015). Treatments of medical complications of anorexia nervosa and bulimia nervosa. Journal of Eating Disorders; 3(15).
  9. Treatment for Anorexia and Bulimia. (2022). American Psychological Association. Accessed August 10, 2022.

Last Update | 11 - 14 - 2022

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