What to Know About Addyi (Flibanserin)

A Controversial Pill for Low Sex Drive in Women

In This Article

Options are limited for medications for treating low sex drive in women. Addyi (flibanserin) is one of only two medications currently approved by the U.S. Food and Drug Administration (FDA) for treating female hypoactive sexual desire disorder (HSDD). Addyi is a non-hormonal pill indicated for premenopausal women only.

The use of this drug remains controversial, mostly due to its potential drug interactions and side effects. In addition, according to various studies, Addyi leads to a minimal to moderate benefit in increasing sexually satisfying events per month.

This makes some experts question whether Addyi is worth the risk and effort (it requires daily use for it to work).

Uses

Addyi is intended for women who have not yet gone through menopause and are experiencing hypoactive (low) sexual desire regardless of their sexual partner, activity, or situation.

HSDD is a sexual dysfunction disorder that involves a reduction or absence of sexual interest that lasts six or more months. It was renamed female sexual interest/arousal disorder in the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5).

This disorder causes distress or interpersonal difficulties and is unattributable to another health concern (e.g., diabetes or depression), medication (e.g., antidepressants), or relationship challenges.

Due to the complexity of HSDD (there is often more than one contributing factor) and to avoid potential side effects and drug interactions (reviewed below), Addyi is usually considered when other therapies, like seeing a sex therapist, have been first thoroughly explored.

How Addyi Works

Addyi is believed to bind to serotonin receptors in the central nervous system, becoming an agonist (activator) on 5-HT1A receptors and an antagonist (blocker) on 5-HT2A receptors.

Of particular note, Addyi works on neurotransmitters, which are brain chemicals. As a result of its action in the brain, dopamine and norepinephrine levels may increase, while serotonin levels decrease. The net effect may be improved sexual desire.

As an aside, and to avoid confusion, Addyi should not be considered "female Viagra." Viagra works by increasing blood flow to the genitals in order to enhance sexual performance. Addyi works in the brain and does not enhance sexual performance.

Effectiveness

While there is scientific evidence that Addyi works, the benefit is considered minimal to moderate by experts. In one study, over 1000 premenopausal women with HSDD were randomized to take either Addyi once at bedtime or a placebo drug for 24 weeks.

Compared to the placebo group, the women who took Addyi had a larger increase in their number of satisfying sexual events per month (2.5 on average with Addyi versus 1.5 for placebo). They also had an increase in sexual desire and a decrease in distress related to sexual dysfunction.

In a large review study that analyzed nearly six thousand women, both premenopausal and postmenopausal, when compared to placebo, Addyi was found to result in small increases in sexual desire, as well as a small increase (one-half per month) of satisfying sexual events.

Before Taking

Prior to starting Addyi, it's important to talk to your doctor about any medical conditions you have. In particular, be sure to mention if you:

  • Drink alcohol or have a history of alcohol abuse
  • Use drugs or have a history of drug abuse
  • Have or have ever had depression or other mental health issues
  • Have low blood pressure or a medical condition that could cause it
  • Are pregnant or planning on becoming pregnant
  • Are breastfeeding

Precautions and Contraindications

If you have liver problems or take any of the following medications (strong or moderate CYP3A4 inhibitors), you should not take Addyi.

Type Specific Drugs

HIV medications

  • Agenerase (amprenavir)
  • Reyataz (atazanavir)
  • Lexiva (fosamprenavir)
  • Norvir (ritonavir)
  • Invirase (saquinavir)
  • Viracept (nelfinavir)
  • Crixivan (indinavir)

Orally-administered fungal infections

  • Diflucan (fluconazole)
  • Nizoral (ketoconazole)
  • Sporanox (itraconazole)
  • Noxafil (posaconazole)

Antibiotics

Hepatitis C medications

  • Victrelis (boceprevir)
  • Incivek (telaprevir)

Other

There may be times when you require one of these medications, however. In those cases:

  • Addyi should be stopped for at least two days prior.
  • Close monitoring for low blood pressure and fainting by your doctor is advised when the benefit of starting one these medications right away outweighs the risk of having adverse effects related to Addyi.
  • Addyi can be restarted two weeks after the last dose of any of these medications you may be taking temporarily (for example, for an infection).

It's also recommended that patients not take Addyi with the following drugs because they can substantially reduce the levels of Addyi in the blood:

  • Tegretol (carbamazepine)
  • Solfoton (phenobarbital)
  • Dilantin (phenytoin)
  • Mycobutin (rifabutin)
  • Rifadin (rifampin)
  • Priftin (rifapentine)
  • St. John’s Wort (an herbal supplement)

As always, be sure to only start and stop a medication under the guidance of your personal physician.

Since it's unknown if Addyi can harm an unborn baby, it should be avoided in pregnancy. Likewise, since it's unknown if Addyi can pass into breast milk, a woman should not take Addyi if she is nursing.

Dosage

Addyi comes in the form of a pink tablet that is taken by mouth. It's important to follow your prescriber's instructions exactly.

According to its label, patients should take one 100 milligram (mg) tablet per day at bedtime. If a dose is missed, the patient should take the next dose at bedtime the following day. The patient should not double the next dose.

If an improvement in symptoms is not noted after eight weeks, the medication should be discontinued (under the guidance of your doctor).

Side Effects

Common side effects associated with Addyi include:

These side effects may be worsened by taking multiple other drugs (called weak CYP3A4 inhibitors) at the same time. Examples of these drugs include:

Warnings and Interactions

Addyi can cause low blood pressure and fainting. This can be increased when combined with moderate or strong CYP3A4 inhibitors, which is why these drugs are contraindicated or, if absolutely necessary, carefully prescribed and monitored.

But other classes of medications may also increase the risk of low blood pressure and fainting. Though they are not contraindicated, it's important to be aware of the potential for these effects:

Taking Addyi within two hours of drinking alcohol also increases the risk of severe low blood pressure and fainting. Therefore, women are advised to discontinue drinking alcohol at least two hours prior to taking Addyi at bedtime or to skip their Addyi dose that evening if three or more alcoholic beverages are consumed.

Then, after taking Addyi at bedtime, patients should not use alcohol until the following day.

Keep in mind—low blood pressure and loss of consciousness are possible side effects even if you don't drink alcohol or take other medications or supplements. If you do lose consciousness, seek medical attention right away.

Women are advised to also avoid drinking grapefruit juice if they are taking Addyi. Finally, Addyi can cause sedation or sleepiness, and this risk is increased with alcohol and certain medications.

As a result of possible sedation, patients are advised not to drive, operate machinery, or engage in activities that require clear thinking until at least six hours after taking Addyi.

A Word From Verywell

If you are suffering from a low sexual desire that is associated with stress, it is important to see your doctor for a full evaluation. While Addyi may be a treatment option for you, your doctor may suggest that you try other therapies first—ones that are perhaps safer and more directly target the cause behind your low sex drive.

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  6. Katz M et al. Efficacy of flibanserin in women with hypoactive sexual desire disorder: results from the BEGONIA trial. J Sex Med. 2013 Jul;10(7):1807-15. doi:10.1111/jsm.12189

  7. Jaspers L, Feys F, Bramer WM, Franco OH, Leusink P, Laan ET. Efficacy and safety of flibanserin for the treatment of hypoactive sexual desire disorder in women: A systematic review and meta-analysis. JAMA Inter Med. 2016;176(4):453-62. doi:10.1001/jamainternmed.2015.8565

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