• Kim Hood, MD

Meds for Libido: Addyi

This also known as flibanserin. Addyi is one of the first 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.

Addyi was not originally created for HSDD. It was originally a medication created for the treatment of depression. During the studies, the medication didn’t really help with depression, but researchers noticed it improved libido in many of the women using the med.

However, due to the study’s failure to prove safety or effectiveness, the FDA did not approve the use of this med in 2010. Over several years, new data was submitted, as well as appeals, and women’s advocacy groups became involved, siting that men had a medication that helped them, and women wanted one also. In 2015, the FDA approved the drug by a panel of 18-6.

When the medication hit the market, there were several things about it that caused physicians great concern. I remembered the pharmaceutical rep that came to my office to let me know about it. The drug had a black box warning that stated the medication caused serious side effects like somnolence and low blood pressure that is exacerbated by alcohol.

Physicians had to take a course to be certified to prescribe it. I remember thinking, “Um…no…if it’s so dangerous that I have to take a course, I’ll pass!” I didn’t even want to take it myself; furthermore, a 30 day supply was $400! Insurance did not pay for it either.

In 2019, the black box warning was dropped, and the requirement for certification was also discontinued. There is a manufacturer’s coupon now, through GoodRx (smart phone app) that a patient will pay no more than $99 per month for the prescription if you have no insurance. It’s lower if you have commercial insurance that cover’s meds.

So, what do you need to know?!?!

No one is really certain how or why Addyi works for libido improvement in women. The quick and dirty is it lowers serotonin in the brain and increases dopamine and norepinephrine. Dopamine is relaxing, makes you feel good, and is what increases when people eat sugar or do certain illegal drugs. Addyi is not habit forming.

In order to use this med, you need to be healthy. I have prescribed this med to women who have controlled blood pressure issues, diabetes, cholesterol issues. However, if the patient requires certain psychiatric meds, it could contribute to increased sleepiness and/or severe low blood pressure.

Addyi can’t be used with certain meds for HIV, yeast medications like Diflucan, antibiotics like cipro, clindamycin, erythromycin, or meds for the heart like diltiazem. You need normal liver and kidney function to use this medication. You can use Addyi if you are on antidepressants.

If you had a normal libido, then started a medication and it went away, Addyi won’t work for you. It would be advisable to work with your doctor to change your meds to see if that would help restore your libido. If the medication could be stopped by making different lifestyle choices or using other alternatives to current treatment, that would be worth exploring.

If you don't like your partner, y'all fight regularly, etc, Addyi won't help that either. You need couples therapy for that.

Addyi does make you incredibly sleepy. Because of that, it is recommended for you to take it at night before bedtime. Many of my patients that required sleeping meds, no longer need them when they start Addyi.

It is a nightly med. You don’t use it just when you are planning for intercourse. It should not make you sleepy during the day. If you feel tired, weak, dizzy or pass out, it could be causing your blood pressure to drop too low. Check your blood pressure, and if it is dropping too low, you will need to not use Addyi.

If you like to have an alcoholic beverage in the evening, you will need to make sure 2 hours or more has passed since your last drink before taking Addyi. If it’s been less than 2 hours or you've had 3 or more alcoholic beverages, then skip Addyi that night. Take your regularly scheduled dose the following night. You never need to double up on Addyi.

Do not eat grapefruit or drink grapefruit juice. This fruit can slow the metabolism of Addyi and make the med last longer and act stronger. Addyi for most women takes effect by 8 weeks; however, I have some patients that said they took it for 16 weeks and noticed improvement at the 12-14 week mark. There is some data that indicates that for some women, it may take 12 weeks to notice improvement.

Do not use this med if you are pregnant, want to be pregnant, or are breastfeeding. It is best to use birth control while on this med.

If you are interested in trying Addyi, make sure you discuss it with your doctor. If you have not already, implemented 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.

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