First Ever Drug Treatment for Binge Eating Disorder Approved

Late on Friday, the FDA approved the first ever drug treatment for binge eating disorder (BED). Lisdexamfetamine — sold under the brand name Vyvanse — is widely used in children and adults to treat attention-deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults.

Lisdexamfetamine quickly gained favor because it is a slower acting form of amphetamine that consequently has less potential for abuse than short acting amphetamines. It’s actually what is called a “pro-drug” because it is inactive until after it is absorbed and then metabolized into its active form. That’s why it acts more slowly, longer, and has less abuse potential.

But less abuse potential is not the same as no abuse potential. In fact, the labeling for Vyvanse carries a boxed warning of “a high potential for abuse and dependence.” And substance abuse is noted to be more common in people with eating disorders. In fact, one of the patients in the phase 2 study for BED “died because of toxicology findings consistent with a methamphetamine overdose.” So clearly this concern deserves close scrutiny.

Then there are other safety issues. The label warns that Vyvanse is not indicated for treatment of obesity, which is common in people with BED. In addition to its addictive properties, Vyvanse has serious cardiovascular risks, including increased heart rate, blood pressure, and sudden death. So use in patients with cardiovascular disease or a family history of sudden death and heart rhythm problems should be avoided.

Stepping back, it’s clear that BED is a serious disease and clinicians who treat it have limited tools. It’s good news to have the first effective drug treatment for this condition available.

We can hope it won’t be the last, because it’s also clear that this treatment comes with important safety concerns. Cognitive behavioral therapy and psychotherapy will no doubt continue to be the cornerstone of care for BED.

More and better options are clearly needed.

Click here to read more from FDA, here to read more from ConscienHealth, and here to read the new prescribing information for Vyvanse (yes, it’s tedious, but it’s the only place where you’ll find a full summary of objective data from BED studies for now).

Vyvanse Capsules, photograph © pichumani / flickr

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