Medication in the treatment of anorexia nervosa

• there is only limited evidence base for the pharmacological treatment of anorexia nervosa. A range of drugs may be used in the treatment of comorbid conditions but caution should be exercised in their use given the physical vulnerability of many people with anorexia nervosa
• medication should not be used as the sole or primary treatment for anorexia nervosa (1)
• caution should be exercised in the use of medication for comorbid conditions such as depressive or obsessive– compulsive features as they may resolve with weight gain alone
• NICE suggest
  • Medication risk management
    • when prescribing medication for people with an eating disorder and comorbid mental or physical health conditions, take into account the impact malnutrition and compensatory behaviours can have on medication effectiveness and the risk of side effects
    • when prescribing for people with an eating disorder and a comorbidity, assess how the eating disorder will affect medication adherence (for example, for medication that can affect body weight)
    • when prescribing for people with an eating disorder, take into account the risks of medication that can compromise physical health due to pre-existing medical complications
    • offer ECG monitoring for people with an eating disorder who are taking medication that could compromise cardiac functioning (including medication that could cause electrolyte imbalance, bradycardia below 40 beats per minute, hypokalaemia, or a prolonged QT interval)
    • previous guidance suggested also (3):
      • healthcare professionals should be aware of the risk of drugs that prolong the QTc interval on the ECG; for example, antipsychotics, tricyclic antidepressants, macrolide antibiotics, and some antihistamines. In patients with anorexia nervosa at risk of cardiac complications, the prescription of drugs with side effects that may compromise cardiac functioning should be avoided

Reference:

1. Prescribers' Journal (1999), 39 (4), 227-233.
2. NICE (May 2017). Eating disorders: recognition and treatment
3. NICE (2004). Eating disorders.