NICE guideline defines place of drug therapy in eating disorders
Recommendations for the management of anorexia nervosa, bulimia nervosa and atypical eating disorders were made this week by the National Institute for Clinical Excellence.
The guideline concentrates on the psychological treatment and assessment
of people with eating disorders but also describes the place of pharmacological
treatments for these conditions.
In particular, it suggests that people with bulimia nervosa can be offered
a trial of an antidepressant drug to reduce the frequency of binge eating
and vomiting. The guideline states that selective serotonin reuptake
inhibitors (SSRIs), specifically fluoxetine, are the drugs of choice
in terms of acceptability, tolerability and reduction of symptoms. It
also points out that for people with bulimia nervosa, the effective dose
of fluoxetine, at 60mg daily, is higher than that for depression.
A trial of SSRIs should also be considered in patients with atypical
eating disorders, says NICE. As in bulimia nervosa, this would be as
an alternative or additional first step to using an evidence-based self-help
programme.
For patients with anorexia nervosa, NICE notes that there is limited
evidence for the use of pharmacological interventions. However, a range
of drugs may be used to treat associated conditions. These should be
used with caution given the physical vulnerability of many people with
anorexia nervosa. With this in mind, NICE warns that all patients with
a diagnosis of anorexia nervosa should have an alert placed in their
prescribing record drawing attention to their heightened risk of developing
side effects.
Other issues highlighted by the guideline include the management of physical
aspects of eating disorders. Where laxative abuse is present, patients
should be advised gradually to reduce their use and should be told that
laxatives do not significantly reduce calorie absorption.
The clinical guideline on eating disorders was issued to the NHS in England
and Wales on 28 January. The guideline is available on the NICE website. |
The
Pharmaceutical Journal