Addyi, Flibanserin

  • Indications
  1. Hypoactive sexual drive in women (libido)
  • Mechanism
  1. Serotonin Agonist-Antagonist
  2. Does not increase sexual organ Blood Flow (unlike Phosphodiesterase Inhibitors such as Viagra)
  • Dosing
  1. One tablet daily at bedtime
  • Efficacy
  1. Premenopausal women may experience 1 more satisfying sexual encounter in 1-2 months (NNT 11)
  2. Only effective if consistently taken daily (and may take 8 weeks of continuous use for full effect)
  • Adverse Effects
  1. Hypotension (especially in liver disease, when taken with Alcohol or when taken with CYP3A4 Inhibitor)
    1. Systolic Blood Pressure dropped >50 mmHg in some cases when combined with Alcohol (NNH 6)
  • Disadvantages
  1. Marginal efficacy in premenopausal women (and less effective in postmenopausal women)
  2. Expensive ($350/month)
  3. Severe Hypotension may occur (esp. with Alcohol, CYP3A4 inhibitors)
  4. Prescribers must undergo REMS training before prescribing
  • Drug Interactions
  1. CYP3A4 inhibitors (e.g. Fluconazole, Grapefruit)
    1. Avoid CYP3A4 inhibitors for 2 weeks before starting Addyi and for 2 days after stopping
    2. Single dose of a strong CYP3A4 inhibitor could significantly raise Addyi doses with Hypotension risk
  • References
  1. (2015) Presc Lett 22(10):60