CNS Drugs

, Volume 33, Issue 1, pp 31–46 | Cite as

Progress in Developing Pharmacologic Agents to Treat Bulimia Nervosa

  • Susan L. McElroyEmail author
  • Anna I. Guerdjikova
  • Nicole Mori
  • Francisco Romo-Nava
Review Article


This paper reviews past and current progress in developing pharmacologic agents for the treatment of individuals with bulimia nervosa (BN). We searched the literature and clinical trial registries for compounds studied in BN, the related condition, binge eating disorder (BED), and preclinical models of binge-eating behavior. Drug classes evaluated included antidepressants, antiepileptic drugs, stimulants and other medications for attention-deficit/hyperactivity disorder, opioid antagonists, and weight loss agents, among others. The only available drugs with established efficacy in BN at this time include antidepressants (especially selective serotonin reuptake inhibitors [SSRIs]) and the antiepileptic topiramate, though the efficacy of these compounds is modest at best. The only medications we found currently receiving empirical study in people with BN were fluoxetine, other serotonergic antidepressants, intranasal naloxone, lisdexamfetamine dimesylate, phentermine–topiramate combination, the antiandrogenic oral contraceptive ethinyl estradiol plus drospirenone, and prazosin. Preclinical models suggest that nociceptin receptor antagonists, the selective serotonin 5-HT2C receptor agonist lorcaserin, monoamine stabilizers, and selective orexin-1 receptor antagonists might be helpful. We found no evidence of a drug developed specifically for the treatment of individuals with BN. Future areas for research in the pharmacotherapy of BN are suggested. Importantly, until drugs are developed specifically for eating disorders, drugs developed for other conditions that are centrally acting and associated with beneficial psychotropic effects and/or reduced appetite or weight loss might be considered for repurposing in BN.


Compliance with Ethical Standards


No sources of funding were used to conduct this study or prepare this manuscript.

Conflicts of Interest

SLM is a consultant to or member of the scientific advisory boards of Allergan, Avanir, Bracket, F. Hoffmann-La Roche Ltd., Mitsubishi Tanabe Pharma America, Myriad, Opiant, Shire, and Sunovion. She is a principal or co-investigator on studies sponsored by the Allergan, Avanir, Brainsway, the  Marriott Foundation, Myriad, Neurocrine, Novo Nordisk, Shire, and Sunovion. She is also an inventor on US patent no. 6,323,236 B2, Use of Sulfamate Derivatives for Treating Impulse Control Disorders, and—along with the patent’s assignee—University of Cincinnati, Cincinnati, Ohio, has received payments from Johnson & Johnson in the past, which has exclusive rights under the patent. AIG, NM, and FR-N have no conflicts of interest that are directly relevant to the content of this article.

Ethical Approval

All procedures performed in studies involving human participants, to the best of our knowledge, were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Susan L. McElroy
    • 1
    • 2
    Email author
  • Anna I. Guerdjikova
    • 1
    • 2
  • Nicole Mori
    • 1
  • Francisco Romo-Nava
    • 1
    • 2
  1. 1.Lindner Center of HOPEMasonUSA
  2. 2.University of Cincinnati College of MedicineCincinnatiUSA

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