Eating Disorder Service
Creating Hope Together

Healthcare Professional's Area

call us: 01244 397 397

Medications

Vitamin and mineral supplements

We would advise that all patients within the anorexic range (BMI<17.5) or patients with a severe restrictive pattern should be prescribed:

SANATOGEN A-Z                       TWO tablets daily

CALCICHEW D3 FORTE           TWO tablets daily

In addition to this, we would advise that patients with BMI < 15 should be prescribed:

THIAMINE                                   100mg twice daily

VITAMIN B CO STRONG          TWO tablets THREE times a day

Nutritional supplements

As a general rule, we try to avoid liquid nutrition, and encourage normal feeding.  There are certain circumstances where we may support the use of short term liquid nutrition for example ENSURE 1-2 cartons per day.

Antidepressants

There is evidence that high dose Fluoxetine can be effective in bulimia nervosa to reduce bingeing and subsequent purging.  The dose needs to be titrated up to 60mg od for maxiumum effect.

SSRIs can be used in attempt to treat depression and anxiety in all eating disorders, however it is important for patients to know that the brain requires 500 calories per day to function noramlly, so any reduction in calories can lead to low mood, anxiety, irritability, poor concentration and memory deficits.

Also, a malnourished brain struggles to produce serotonin and therefore SSRI medication have a limited role in low weight patients.  Guidance and clinical practice suggests that low weight patients require higher doses for this reason, rather than lower doses as one would expect. Patients are usually wise to the weight gaining side effects of medications so we tend to stick to SSRIs for that very reason.

Antipsychotics

There is mixed evidence for the use of antipsychotic medication in anorexia nervosa.  The aim of their use is to attempt to reduce rigid and obsessional thinking, as well as help with sleep, over-arousal, anxiety etc.  This of course would be off-license and requires a lot of thought and discussion.

Antipsychotic medication should be used with caution due to side effects of sedation, hypotension, cardiac abnormalities, blood dyscrasias etc. Again, a lot of patients are reluctant to try this type of medication due to possible weight gaining side effects. We tend to use smaller doses than the doses in psychosis, for example Risperidone 0.25 - 1.0mg nocte.

Potassium supplements

Please refer to our guidance on the management of hypokalemia