Medications for Binge Eating Disorder

Introduction to Treatment Approaches

The American College of Cardiology is not applicable here, however, medications should be considered when patients prefer medication over psychotherapy, have not responded adequately to psychotherapy alone, or have comorbid obesity 1, 2

Psychotherapy, particularly cognitive-behavioral therapy (CBT) or interpersonal therapy, is recommended as the initial treatment for binge eating disorder (BED) 2

Lisdexamfetamine is the only FDA-approved medication specifically for moderate-to-severe binge eating disorder 2
Dosing typically follows a titration protocol to minimize side effects 2

Topiramate has substantial evidence for reducing binge eating behaviors and is often used as part of combination therapy (e.g., phentermine/topiramate ER) 2
Naltrexone/Bupropion (Contrave) has evidence for weight management and is particularly useful for patients who describe food cravings or addictive eating behaviors 2
This combination may benefit patients with comorbid depression or those trying to quit smoking 2

Lisdexamfetamine is considered for patients with moderate-to-severe BED, especially when weight management is a goal 2
Naltrexone/bupropion is considered for patients with significant food cravings or addictive eating patterns 2
Topiramate or naltrexone/bupropion are considered for patients with obesity as primary concern 2, 2

Avoid weight gain-inducing medications such as mirtazapine and tricyclic antidepressants in BED patients with obesity 2
Monitor for side effects and adjust dosing as needed for long-term treatment 2

BED is associated with the development of obesity and affects individuals of all genders 1
BED is particularly prevalent in women and may be exacerbated in those with polycystic ovary syndrome (PCOS) 3
The lifetime prevalence of binge eating disorder in adolescent females is approximately 1.6% 4, 5

The American Gastroenterological Association recommends topiramate for reducing binge eating behaviors and body weight, particularly in patients with obesity as the primary concern 6
The National Institute of Health suggests naltrexone/bupropion (Contrave) is beneficial for patients describing food cravings or addictive eating behaviors, and may also benefit patients with comorbid depression or those trying to quit smoking 6
The American Gastroenterological Association notes that topiramate must be avoided in patients with a history of cardiovascular disease and uncontrolled hypertension, and is teratogenic 6
The American Heart Association recommends monitoring blood pressure and heart rate periodically, especially during the first 12 weeks of naltrexone/bupropion treatment 6

The American Gastroenterological Association advises against using mirtazapine and tricyclic antidepressants in patients with binge eating disorder and obesity due to the potential for weight gain 6

The American Diabetes Association suggests considering GLP-1 analogues (e.g., liraglutide) for patients with type 2 diabetes, which reduce hyperglycemia in addition to first-line metformin 6
The American Gastroenterological Association notes that liraglutide 3.0 mg has glucoregulatory benefits and is also approved for the treatment of type 2 diabetes 6