{ "schema_version": 1, "kind": "condition", "id": "bulimia-nervosa", "name": "Bulimia Nervosa", "category": "chronic", "sources": "NICE Guideline NG69: Eating disorders: recognition and treatment 2017 (updated 2020) · Fluoxetine 20 mg Capsules SmPC section 4.2 (eMC product 11909) · LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070)", "review_status": "reviewed", "verified_against": "Fluoxetine 20 mg Capsules SmPC section 4.2 (eMC product 11909) · LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070) · Bulimia Nervosa - disease-level clinical article (bulimia-nervosa-full.txt) · Bulimia Nervosa - disease-level clinical article (bulimia-nervosa-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 324, "generic": "Fluoxetine", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 20.0, "adult_dose": "60 mg once daily", "adult_duration": "Review at 3 months. The label is explicit that long-term efficacy beyond 3 months has not been demonstrated in bulimia", "dose_source": "Fluoxetine 20 mg Capsules SmPC section 4.2 (eMC product 11909)", "rationale": "60 mg a day is the licensed bulimia dose and it beat placebo on bingeing, vomiting and purging in trials under 16 weeks. Beyond three months no conclusion can be drawn, and no source supports a '6-12 months minimum'.", "cautions": [ "Evidence-based eating disorder psychological therapy (CBT-ED) is the primary first-line treatment; pharmacotherapy is an adjunct or alternative.", "Check baseline and periodic serum electrolytes (potassium, sodium, magnesium) and ECG due to risk of hypokalemic metabolic alkalosis and QT prolongation from vomiting/laxative abuse.", "Increased risk of suicidal ideation in young adults (<25 years) during initial weeks of therapy.", "Bupropion is strictly contraindicated in bulimia nervosa due to severe risk of drug-induced seizures.", "NICE NG69 does not name a drug or a dose for bulimia. Its only medication recommendation is not to offer medication as the sole treatment - the treatment is guided self-help or CBT-ED, and this sits alongside it.", "Fluoxetine is contra-indicated in combination with irreversible, non-selective monoamine oxidase inhibitors (e.g. iproniazid).", "Fluoxetine is contra-indicated in combination with metoprolol used in cardiac failure." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children and adolescents <18 years require specialist child/adolescent eating disorder service referral; fluoxetine 60 mg/day efficacy is unestablished in under-18 bulimia (BNFC 2024).", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "FLOROSIN 20MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UP PHARMA", "price_egp": 11.0, "pack_count": 10, "unit_price": 1.1, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PHILOZAC 20MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 11.0, "pack_count": 10, "unit_price": 1.1, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLUOXETINE 20 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 18.6, "pack_count": 10, "unit_price": 1.86, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ELEVAMOOD 20 MG 28 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UNIPHARMA", "price_egp": 56.0, "pack_count": 28, "unit_price": 2.0, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OCTOZAC 20MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "OCTOBER PHARMA", "price_egp": 21.6, "pack_count": 10, "unit_price": 2.16, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PHILOZAC 20MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 75.0, "pack_count": 30, "unit_price": 2.5, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PROZAC 20MG 14 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ELI LILLY", "price_egp": 118.0, "pack_count": 14, "unit_price": 8.43, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLUOXETINE 20 MG H.G.CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 8.0, "pack_count": null, "unit_price": null, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "bulimia-nervosa" }, { "id": 325, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Bulimia Nervosa - disease-level clinical article (bulimia-nervosa-full.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Perform an initial medical evaluation to determine medical stability and whether hospitalization is needed.", "RED FLAG - A cardiology consult is needed for severe or symptomatic cardiac complications from electrolyte derangement.", "RED FLAG - Screen for suicidality and comorbid psychiatric illness." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "bulimia-nervosa" }, { "id": 323, "generic": "Sertraline", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 50.0, "adult_dose": "50 mg once daily in morning, titrate by 50 mg weekly to target 100-200 mg daily", "adult_duration": null, "dose_source": "LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070)", "rationale": "Off-label SSRI alternative when fluoxetine is not tolerated or contraindicated. Fluoxetine's own SmPC (eMC 11909) licenses it specifically for bulimia nervosa at 60 mg/day (\"Fluoxetine is indicated as a complement of psychotherapy for the reduction of binge-eating and purging activity\"); no cached document licenses sertraline for this indication, and NG69 does not name a drug for bulimia at all.", "cautions": [ "Monitor for GI side effects, hyponatremia, and serotonin syndrome.", "Electrolyte screening mandatory prior to initiation.", "Do not abruptly stop therapy due to SSRI discontinuation syndrome.", "Off-label and not in NG69, which does not mention sertraline at all. It is here for the patient who cannot take fluoxetine; there is no bulimia-specific licensed dose behind it.", "Concomitant treatment with irreversible monoamine oxidase inhibitors (MAOIs) is contraindicated due to the risk of serotonin syndrome with symptoms such as agitation, tremor and hyperthermia.", "Concomitant intake of pimozide is contraindicated (see section 4.5)." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist eating disorder service referral required.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "OPIRALINE 50 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL-OBOUR", "price_egp": 29.0, "pack_count": 20, "unit_price": 1.45, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AGRELOCIT 50 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS > ATM PHARMACEUTICAL INDUSTRIES", "price_egp": 34.8, "pack_count": 20, "unit_price": 1.74, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEPR-STAT 50MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 21.6, "pack_count": 10, "unit_price": 2.16, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SESERINE 50MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ADWIA", "price_egp": 75.0, "pack_count": 30, "unit_price": 2.5, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SERPASS 50MG 30 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS", "price_egp": 102.0, "pack_count": 30, "unit_price": 3.4, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SIRTO 50MG 10 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HI-PHARM", "price_egp": 34.0, "pack_count": 10, "unit_price": 3.4, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MOODAPEX 50 MG 30 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX", "price_egp": 111.0, "pack_count": 30, "unit_price": 3.7, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LUSTRAL 50 MG 20 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "VIATRIS", "price_egp": 136.0, "pack_count": 20, "unit_price": 6.8, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "bulimia-nervosa" } ] }