It’s widely known that men have a little blue pill called Viagra® for erectile dysfunction, but did you know that women have a little pink pill called Addyi® (flibanserin) for Hypoactive Sexual Desire Disorder? It’s been around since 2015, but still few women know about it. Decreased libido or sex drive is a common concern in women I see in my practice especially in perimenopause. Hypoactive sexual desire disorder is characterized by bothersome decreased sexual interest for 6 months or longer in the absence of any explanatory cause like a medical condition, medication, life stressor, relationship, or other issue.
I’ve blogged about HSDD here, but I just wanted to highlight that there is an oral prescription to treat HSDD because it’s still not something women commonly hear or know about. Now, not every woman wants to take a daily pill. In fact, most of my patients tend to avoid all medications, but if everything else has been tried without success, HSDD may warrant a prescription medication.
Flibanserin is a once-daily pill to be taken at bedtime. It’s FDA-approved for premenopausal women but has been shown in a clinical study to be effective for menopausal women. It’s non-hormonal and works through altering brain chemistry that can inhibit interest in sexual activity. Three separate randomized, double blind, placebo-controlled trials were conducted in women 19-55 years of age over 24-weeks in 1177 women taking flibanserin vs. 1198 taking placebo. Women were shown to increase their number of satisfying sexual events (SSEs) over their previous baseline by 1 SSE in a 28 day period. In one of the three studies involving over 500 women, women were shown to have a statistically significant improvement in sexual desire and reduced distress associated with low sexual desire. These results may not sound that exciting, but if you are only having sex twice a month and flibanserin increases this to three times a month, that’s a 50% improvement. Also, satisfying sexual activity may beget more sexual interest and desire independent of the medication.
Flibanserin may produce results in the first 4 weeks. If a woman has no results in 8 weeks, it is recommended to discontinue the medication.
Most common side effects of flibanserin are low blood pressure, dizziness, insomnia, excess sleepiness, fatigue, and dry mouth. It’s important to take the medication at bedtime and not drive, operate machinery or do anything that requires clear thinking for 6 hours after taking it.
Drinking alcohol can increase the risk of low blood pressure, so it’s recommended to wait 2 hours after drinking alcohol to take flibanserin and limit evening alcohol intake to 2 drinks or less. It’s recommended to avoid the night’s flibanserin dose altogether if you’ve had 3 drinks. Depending on how alcohol affects you, it may be safer to skip flibanserin if you’ve had only 2 drinks. When I say 1 drink, I am referring to standard alcohol equivalents which include 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of distilled spirits.
Flibanserin should be avoided in women taking certain medications and herbal supplements. It’s important to talk to your doctor about all the medications and supplements you are taking to make sure you are not at increased risk for adverse effects of the medication. Certain medications can cause the flibanserin levels to be increased and increase your risk of low blood pressure or fainting. Flibanserin shouldn’t be used if you are pregnant, may become pregnant, or are nursing. Oh my gosh, is this starting to sound like a drug company commercial or what?!
I haven’t had many postmenopausal women try flibanserin. It’s been FDA-approved for premenopausal women, but I’ll discuss off-label use with my postmenopausal women. Off-label refers to using a medication for different patient conditions or in differing doses than what the FDA approved, and there may not be any studies on efficacy and safety. Older women tend to have more medical problems and take more medications that can increase their risk of medication side effects, so off-label use should be discussed thoroughly before initiating treatment. Testosterone is another off-label therapy for HSDD, and there is also another FDA-approved injectable medication, bremelanotide, which is approved to treat HSDD in premenopausal women.
If you have decreased sexual interest or think you may have HSDD, talk to your doctor about evaluation and treatment options. If you want to schedule a virtual consult with me or be seen as a patient in my clinic, you can go here.
This post is for informational purposes and is not medical advice.