• Kim Hood, MD

Med for Libido: Vyleesi

This is also known as bremelanotide. Vyleesi is one of the more recent medications approved for the treatment of (HSDD) – Hypoactive Sexual Desire Disorder. HSDD is characterized by the loss of desire for sex in a premenopausal woman that once had a desire for sex. The loss has been for 6 months or more, causes distress in her relationship, and is not caused by relationship issues, health issues, meds, or a psychiatric diagnosis.

Vyleesi was not originally created for HSDD. Of the meds for HSDD, I believe it has one of the most interesting histories. This medication stimulates melanocortin receptors. It was originally created as a sunless tanning agent back in the early 2000’s!

When doing studies on the peptide analogs of this drug, they noticed the rats were sexually aroused. (Don’t ask me what that looks like!) However, one of the scientists decided to inject himself to see what would happen. He accidentally injected himself with too much and had an erection for 8 hours! Great, right?!?!? NO! He had terrible nausea and vomiting, and I won’t get started on the dangers and consequences of an 8 hour erection.

The drug was reformulated several times over the years. At one point, the FDA shut down the trials due to significant blood pressure elevations in the test subjects. It did not help with tanning, but the drug companies pursued the improvement in libido angle. After further studies and reformulations, the med finally passed its’s phase III trials. It was released to market in 2019.

No one is entirely certain how or why it helps women with libido. It is an injectable medication to be used 45 minutes prior to planned intercourse. The main side effect? 40% get nauseated! You may need a prescription for Zofran (anti-nausea med) to go along with the Vyleesi.

Other side effects: 20% will get flushing and many may develop skin discoloration at the injection site, especially if the med is used 8 times per month. The discoloration may also affect face, gums, and breasts and may be permanent. You can only use 8 doses max per month, and only take 1 dose in a 24 hour period.

This medication is not for patients with uncontrolled blood pressure issues, as it can raise blood pressure. Fortunately, this formulation does not raise it significantly like some of the earlier formulations.

It is not for patients with significant liver or kidney function problems. You cannot take this med if you are on naltrexone. Indomethacin can be affected by this med and has to be monitored closely. AND do not use if you are pregnant, want to be pregnant or are breastfeeding. Please use birth control if you use this medication.

If you are interested in trying Vyleesi, make sure you discuss it with your doctor. If you have not already, implement date night with your significant other several times per month. Plan some get away’s. Even though you may live together, you may not be “connecting” because life can be so distracting. Maintaining that relationship is very important for your libido also. This medication can cost about $3000 for 4 prefilled injections. However, GoodRx (smart phone app) has a manufacturer’s coupon. You can get it for $0 your first month and no more than $99 per month thereafter, even if you do not have insurance!

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