As a practicing GYN in New York City, I am getting a lot of calls lately from my predominantly perimenopausal and menopausal patients, asking whether they are candidates for Flibanserin (ADDYI™). Whenever a new drug comes along, I am always cautious about prescribing it, until I feel certain that I understand all the benefits and risks. And in the case of Flibanserin (ADDYI™), it is also very important to narrow down who are the right candidates for this new medication.
What is Flibanserin (ADDYI™)? Well, it started out life trying to be an antidepressant, affecting the serotonin receptors in the brain. During the clinical trials, women noticed that they had improvement in their sexual desire, so Flibanserin (ADDYI™) research took a turn into the area of women’s sexual health. There were several pivotal studies done in both premenopausal and menopausal women.
What were the results? Well it turns out that Flibanserin (ADDYI™) showed a modest improvement in sexual desire in a very specific population of women who carry a diagnosis for hypoactive sexual desire disorder (HSDD). The HSDD diagnosis is made when women experience a reduced libido and are distressed about it. Their history includes the fact that these women had a healthy interest in sex at some point, no longer have it now, are really bothered about it and want their desire back. Also, there can be no other reasons to explain low libido, like being in a difficult relationship, experiencing painful intercourse, taking certain medications and so forth.
How will you know if your low libido is due to HSDD? There is a Decreased Sexual Desire Screener (DSDS) that has five questions. Depending on how you answer those questions will result in whether you actually qualify for the diagnosis and possibly the new drug.
There are some down sides to Flibanserin (ADDYI™), which include the fact that improvement in sexual interest was modest and did not work for everyone. If this daily medication does not improve your interest within 8-12 weeks, it should be discontinued. In addition to causing dizziness, sleepiness and fatigue, Flibanserin (ADDYI™) also has a significant interaction with alcohol which can lead to low blood pressure and fainting. The FDA label will have a strong warning against the use of alcohol when taking Flibanserin (ADDYI™).
Despite the fact that Flibanserin (ADDYI™) was tested and worked in both premenopausal and menopausal women with the diagnosis of HSDD, it is currently only approved for premenopausal women. The reason for that is because more studies are required in the menopausal population before the FDA can approve it. So if you are a menopausal woman with HSDD and are interested in trying this medication when it becomes available, your insurance company is not likely going to pay for it. Using this drug will be considered “off label”.
The bottom line for all of you who are experiencing a bothersome decrease in libido is that you have to find a qualified health care professional to help you figure it all out. Your solution is probably not as simple as getting a prescription for the newest drug in town. However, all the recent splashy headlines about Flibanserin (ADDYI™) have definitely allowed more women to feel empowered to talk about this very important issue. So let’s keep this conversation going!
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