Flibanserin (Addyi) and Female Sexual Dysfunction
Can this medication help women with hyposexual desire disorder in the UK?
Flibanserin is a medication for treating one particular disorder related to low sex drive in women
Flibanserin is available in the US but not in the UK
Flibanserin works in the brain, compared to pills like Viagra which affect blood flow
Reviews for flibanserin are mixed - some see it as a simplistic solution marketed for a complex problem
Flibanserin is not used for women going through the menopause as there isn't enough evidence to prove it's safe for them
What is Flibanserin (Addyi)?
It's a treatment for a specific condition – Flibanserin (brand name ‘Addyi’) is a medication which is used to treat Hypoactive Sexual Desire Disorder (HSDD) in women who have not gone through the menopause. HSDD is a condition where a woman has low sex drive (or libido) which causes them distress. The low sex drive happens no matter who the partner or what the situation is.
Flibanserin is not used to treat low sex drive if:
- It is caused by relationship problems, a lack of time, or a lack of energy
- It is caused by a medication that you take
- It is caused by a different medical or mental health condition
It's available in the US but not here in the UK – Flibanserin was licensed for use in the US by the Food and Drugs Administration (FDA) in 2015. However, currently it’s not licensed for use in the UK.
How does Flibanserin improve sexual function?
Flibanserin improves sexual desire by affecting the level of neurotransmitters (specific chemicals) in the brain – it does not work in the same way as male erectile dysfunction treatment, which improves blood flow to the genital area. Also Flibanserin needs to be taken daily, whereas erectile dysfunction medications can be used on demand (only when needed).
Historically, Flibanserin was actually developed as an antidepressant – trials of the medicine found that Flibanserin doesn’t work very well for that purpose. However, researchers noticed that patients who took part in the trial had increased libido. So, manufacturers hoped that Flibanserin could instead work to improve low sexual desire.
Studies which look at the effectiveness of Flibanserin found that it works – but only slightly better than dummy pills (placebo). Dummy pills are used in clinical research because people can have a response when they think they’re receiving treatment even if it’s actually just a dummy treatment. So, these studies can tell us that some of the effects that people experience from Flibanserin are not because of the medicine itself.
Reviews of Flibanserin have been mixed – some say that the small improvement still brings significant benefits to relationships and quality of life, while others see it as aggressive marketing of a simplistic solution to women’s sexual dysfunction.
Why isn’t Flibanserin used for menopausal women?
Flibanserin is a relatively new medicine – for a new medicine to get a licence, it must pass several rounds of clinical research to prove that it is safe and that it works. As more and more studies are done into Flibanserin, evidence for the safety and effectiveness of the medicine becomes stronger.
The research hasn't been done on Flibanserin and menopause – at the moment, Flibanserin is only licensed for use in women who have not gone through the menopause because most of the research that has been done into the medicine involves participants who are premenopausal. There have been studies done which found that it is also safe and effective in postmenopausal women, but currently there is not enough evidence to license the use of Flibanserin in these women.
This could change in the future – it could be that once more research goes into the effects of Flibanserin and menopausal women, if it’s found that the medication is safe for them, then it may become available for them too.
Are there any risks involved in using Flibanserin?
There are some side effects which are associated with using Flibanserin:
- Dizziness, feeling faint, or fainting
- Feeling tired
- Feeling sick (nausea)
- Feeling sleepy or sedated
Flibanserin is not recommended for use if:
- You have a condition that affects your liver. This affects the way that Flibanserin is processed in your body
- You are breastfeeding. There are currently no studies looking into the use of Flibanserin in mothers who are breastfeeding so there is no way to know whether Flibanserin can be passed on to the baby through breast milk
- You drink alcohol. You are much more likely to experience the side effects of Flibanserin if you also drink alcohol
Long-term risks and cost/benefit trade-off – because Flibanserin is a very new medicine, it is not possible to predict the long term effects of using it. Part of the skepticism around Flibanserin as a medication is because the positive effects of Flibanserin are relatively small, but the side effects can be significant.
What can you do about sexual dysfunction?
Currently, there is no medication that is licensed for use in the UK for low sexual desire in women – however, some people have found that taking some herbal supplements such as Prelox can help with their symptoms. Prelox works in much the same way as male erectile dysfunction medication (like Viagra) by improving blood flow to the genitals.
There are lifestyle changes that can be made which is associated with better sexual desire – these changes include:
- Quit smoking
- Avoid drinking alcohol, especially when you plan to have sex
- Eat a healthy diet with lots of fruit and vegetables and low saturated fat
- Exercise regularly
Some people find that by making these changes, they don’t need any medication to improve their libido.
You can make a consultation with a doctor about sexual problems – they can help if:
- Sexual problems are caused by a condition you have. Getting the condition under control may improve your symptoms
- Medications that you are taking. A doctor can review your medications to see whether some of your symptoms is caused by this
- Sexual problems are caused by psychological problems. They can recommend psychosexual therapy or counselling to help deal with this
Bottari, A. et al (2013). Lady Prelox® improves sexual function in generally healthy women of reproductive age. Minerva Ginecologica, Aug; 65(4): 435-444.
Jaspers, L. et al (2016). Efficacy and safety of Flibanserin for the treatment of hypoactive sexual desire disorder in women: a systematic review and meta-analysis. JAMA Intern Med, Apr; 176(4): 453-462.
Medscape. Flibanserin (Rx). medscape.com. [online] Available at: https://reference.medscape.com/drug/addyi-flibanserin-1000025#10 [accessed 4th July 2018].
Portman, D. J. et al (2017). Flibanserin in postmenopausal women with hypoactive sexual desire disorder: results of the PLUMERIA study. J Sex Med, Jun; 14(6): 834-842.
Sprout Pharmaceuticals (2016). ADDYI. Valeant. [online] Available at: http://www.valeant.com/Portals/25/Pdf/PI/Addyi-PI.pdf [accessed 4th July 2018].
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