What to Know About Addyi (Flibanserin)

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In This Article

When it comes to medications for treating female sexual dysfunction, options are limited. Addyi (flibanserin) is one of two medications currently approved by the U.S. Food and Drug Administration (FDA) to treat female hypoactive sexual desire disorder (HSDD). Addyi is an oral, non-hormonal option indicated for premenopausal women only.

In clinical trials, Addyi led to small increases in both sexual desire and the number of satisfying sexual events per month. However, the use of this drug may be limited by its side effects and potential drug interactions.

Uses

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

HSDD is a sexual dysfunction disorder that refers to a reduction or absence of sexual interest in a woman that lasts six or more months. 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.

How Addyi Works

While the exact mechanism of action for Addyi is unknown, the drug 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, not hormones.

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.

Addyi should not be considered "female Viagra." Viagra works by increasing blood flow to the genitals using a completely different mechanism and affecting a different site of action (genitals vs. the brain).

Effectiveness

In a large study that analyzed multiple clinical trials of nearly six thousand women, 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.

This means that, for example, if a woman reported two satisfying sexual events per month before taking the medication, she reported two and a half after taking Addyi.

Generally speaking, it takes eight weeks for Addyi to be effective.

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

Contraindications and Recommendations

You should not drink grapefruit juice if you take Addyi. In addition, if you have liver problems or take any of the following medications, you should not take Addyi. 

Certain HIV-1 medications:

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

Certain orally-administered fungal infections:

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

Certain antibiotics:

  • Cipro (Ciprofloxacin)
  • Telithromycin (Ketek)
  • Erythrocin (erythromycin)
  • Biaxin (clarithromycin)

Certain hepatitis C medications:

  • Victrelis (boceprevir)
  • Incivek (telaprevir)

Certain high blood pressure or angina medications:

  • Cartia (diltiazem)
  • Calan (verapamil)
  • Vaprisol (conivaptan)

Nefazodone (only generic available) is an antidepressant that is also contraindicated.

In addition, it's recommended that patients not take Addyi with certain drugs because they can substantially reduce the levels of Addyi in the blood.

These drugs include:

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

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 you miss a dose, do not double the next dose or take it the next morning; simply take your next dose at bedtime the following day.

Side Effects

Common side effects associated with Addyi include:

  • Dizziness
  • Sleepiness
  • Nausea
  • Dry mouth
  • Insomnia
  • Fatigue

These side effects may be worsened by taking certain other drugs, such as oral contraceptives, the antidepressant Prozac (fluoxetine), or the herbal supplement ginkgo (Ginkgo Biloba).

Moreover, Addyi can cause low blood pressure and fainting, and these serious risks are increased when the drug is combined with certain classes of medications—specifically, proton pump inhibitors, selective serotonin reuptake inhibitors, benzodiazepines, and antifungals.

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.

Lastly, because of all these potential adverse reactions, patients are advised not to drive, operate machinery, or engage in activities that require clear thinking until at least six hours after taking Addyi.

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.

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. While medications like Addyi may be an option for you, there are other therapies available, such as seeing a sex therapist or couples counselor. An extra bonus with these non-pharmacologic therapies is that you can avoid the risk of side effects or drug interactions.

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Article Sources
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  1. Food and Drug Administration. Addyi Medication Guide. Updated October 2019.

  2. U.S. National Library of Medicine. National Center for Biotechnology Information. Flibanserin.

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