Flibanserin (Addyi)

What is it for? – 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 a 'low libido' (or 'low sex drive/desire') which causes them distress. The low sexual desire happens no matter who the partner or what the situation is.

What is it not for? – because it's only for specific sexual dysfunction in women, Flibanserin is not used to treat low sexual desire 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

Where is it available? – Flibanserin has been licensed for use in the US by the Food and Drugs Administration (FDA) in 2015. However, currently it is not licensed for use in the UK.

Flibanserin works on the brain – Flibanserin improves sexual desire by affecting the level of neurotransmitters in the brain. It does not work in the same way as male erectile dysfunction (ED) medication, which improves blood flow to the genital area – but it could be described as 'Viagra for women' because it also treats sexual dysfunction. Also Flibanserin needs to be taken daily, whereas erectile dysfunction medications can be used on demand (only when needed).

It was developed as an antidepressant – historically, Flibanserin was actually developed as an antidepressant. Trials of the medicine found that, unfortunately, Flibanserin doesn’t work very well for this 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.

Research shows some success in treating low sex drive – 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 to taking a dummy when they think they are receiving 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.

There has not been enough research 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.

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.

Future licencing for during the menopause – 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.

Flibanserin side effects – there are some side effects which are associated with using Flibanserin, including:

• 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 pregnant or breastfeeding. There are currently no studies looking into the use of Flibanserin in women who are pregnant or breastfeeding so there is no way to know whether Flibanserin can be passed on to the baby through breast milk or harm an unborn baby.
• You drink alcohol. You are much more likely to experience the side effects of Flibanserin if you also drink alcohol.

Risks and benefits – also, because Flibanserin is a very new medicine, it is not possible to predict the long term effects of using the medicine. Part of the skepticism around Flibanserin as a medication is because the positive effects of Flibanserin are small, but the side effects can be stronger.

There are a lot of different options that can help women with sexual dysfunction.

Although, there is no licensed medication for the UK – 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 (ED) medication by improving blood flow to the genitals.

Lifestyle options – studies in men show that there are lifestyle changes that can be made which may be associated with better sexual desire. These changes include:

• Quit smoking
• Not drinking alcohol, especially when you plan to have sex
• Eating a healthy diet with lots of fruit and vegetables and low saturated fat
• Exercising regularly
• Some people find that by making these changes, they don’t need any medication to improve their libido.

Seeing your GP – 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