Fluoxetine Dose in Bulimia — MRCPsych Paper B MCQ

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EasyEating DisordersFluoxetine Dose in BulimiaMRCPsych Paper B

A 25-year-old woman with bulimia nervosa is receiving specialist psychological treatment. Fluoxetine is being considered as a pharmacological complement. According to the UK Summary of Product Characteristics, what is the recommended daily dose of fluoxetine for this indication?

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Correct answer: E — 60 mg once daily

Explanation lettering: B = shown as A · E = shown as B · D = shown as C · A = shown as D · C = shown as E

The correct answer is C: 60 mg once daily. The UK SmPC states that for bulimia nervosa in adults a dose of 60 mg/day is recommended, with fluoxetine licensed as a complement to psychotherapy for reducing binge-eating and purging; short-term trials showed 60 mg/day was superior to placebo. Option B (20 mg) is the recommended dose in a major depressive episode and is the commonest error, being a sub-therapeutic starting dose for this indication. Option A (10 mg) is a low dose used when cautious initiation is needed, not the indication-specific recommendation. Options D and E exceed the licensed maximum of 60 mg/day for bulimia nervosa and increase adverse effect risk without evidence of benefit. NICE NG69 adds that medication must not be the sole treatment for bulimia nervosa.

Reference: Electronic Medicines Compendium. Fluoxetine 60 mg Capsules – Summary of Product Characteristics, sections 4.1 and 4.2 (bulimia nervosa: 60 mg/day), current version 2024. https://www.medicines.org.uk/emc/product/7088/smpc