NEDA TOOLKIT for Parents
Pharmacological Interventions for Anorexia
Nervosa C — There is a very limited evidence base for the
pharmacological treatment of anorexia nervosa. A
range of drugs may be used in the treatment of
comorbid conditions but caution should be exercised
in their use given the physical vulnerability of many
people with anorexia nervosa.
C — Medication should not be used as the sole or
primary treatment for anorexia nervosa.
Caution should be exercised in the use of medication
for comorbid conditions such as depressive or
obsessive-compulsive features, as they may resolve
with weight gain alone.
C — When medication is used to treat people with
anorexia nervosa, the side effects of drug treatment
(in particular, cardiac side effects) should be carefully
considered because of the compromised
cardiovascular function of many people with anorexia
nervosa. C — Health care professionals should be aware of the
risk of drugs that prolong the QTc interval on the
electrocardiogram (ECG) (for example, antipsychotics,
tricyclic antidepressants, macrolide antibiotics, and
some antihistamines). In patients with anorexia
nervosa at risk of cardiac complications, the
prescription of drugs with side effects that may
compromise cardiac functioning should be avoided.
C — If the prescription of medication that may
compromise cardiac functioning is essential, ECG
monitoring should be undertaken.
C — All patients with a diagnosis of anorexia nervosa
should have an alert placed in their prescribing record
concerning the risk of side effects.
Physical Management of Anorexia Nervosa
Managing Weight Gain
C — In most patients with anorexia nervosa, an
average weekly weight gain of 0.5-1 kg in inpatient
settings and 0.5 kg in outpatient settings should be an
aim of treatment. This requires about 3,500 to 7,000
extra calories a week.
C — Regular physical monitoring, and in some cases
treatment with a multi-vitamin/multi-mineral
supplement in oral form, is recommended for people
with anorexia nervosa during both inpatient and
outpatient weight restoration.
C — Total parenteral nutrition should not be used for
people with anorexia nervosa, unless there is
significant gastrointestinal dysfunction.
Managing Risk
C — Health care professionals should monitor
physical risk in patients with anorexia nervosa. If this
leads to the identification of increased physical risk,
the frequency of the monitoring and nature of the
investigations should be adjusted accordingly.
C — People with anorexia nervosa and their carers
should be informed if the risk to their physical health
is high.
C — The involvement of a physician or pediatrician
with expertise in the treatment of physically at-risk
patients with anorexia nervosa should be considered
for all individuals who are physically at risk.
C — Pregnant women with either current or remitted
anorexia nervosa may need more intensive prenatal
care to ensure adequate prenatal nutrition and fetal
development. C — Oestrogen administration should not be used to
treat bone density problems in children and
adolescents as this may lead to premature fusion of
the epiphyses.
Anorexia nervosa carries considerable risk of serious
physical morbidity. Awareness of the risk, careful
monitoring, and, where appropriate, close liaison with
an experienced physician are important in the
management of the physical complications of
anorexia nervosa.
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