Medication algorithm for bulimia nervosa*

BMI: Body mass index.
* Pharmacotherapy combined with nutritional rehabilitation and psychotherapy is indicated for bulimia nervosa. However, if nutritional rehabilitation and psychotherapy are not available, pharmacotherapy alone is reasonable. In addition, pharmacotherapy is indicated for comorbid anxiety disorders and depressive disorders. Medication choices depend upon the factors addressed in this algorithm, as well as other factors, including past treatment history. Response is often defined as reduction of symptoms ≥50%. The duration of an adequate medication trial is generally four to eight weeks. Refer to the UpToDate topic on pharmacotherapy for bulimia nervosa for full details of using medications.