Flibanserin: Uses, Effects & Side Effects
Flibanserin is a prescription medication approved for treating hypoactive sexual desire disorder in premenopausal women. It acts on brain neurotransmitters and was the first drug of its kind to receive FDA approval.
Things worth knowing about "Flibanserin"
Flibanserin is a prescription medication approved for treating hypoactive sexual desire disorder in premenopausal women. It acts on brain neurotransmitters and was the first drug of its kind to receive FDA approval.
What Is Flibanserin?
Flibanserin is a prescription medication approved for the treatment of hypoactive sexual desire disorder (HSDD) in premenopausal women. HSDD is characterized by a persistent lack of sexual desire that causes significant personal distress or interpersonal difficulties. Flibanserin was the first drug approved by the U.S. Food and Drug Administration (FDA) for this indication in 2015 and is marketed under the brand name Addyi. It is currently not approved in the European Union.
Mechanism of Action
Unlike medications that work by increasing blood flow (such as sildenafil in men), flibanserin targets the neurochemistry of the brain. It acts as a:
- Agonist (activating) at serotonin 5-HT1A receptors
- Antagonist (inhibiting) at serotonin 5-HT2A receptors
- Antagonist at dopamine D4 receptors
This complex receptor profile is thought to rebalance the neurotransmitters involved in sexual desire. Specifically, flibanserin is believed to increase levels of dopamine and norepinephrine (which promote sexual desire) while reducing serotonin activity (elevated serotonin is associated with reduced libido).
Indication and Usage
Flibanserin is indicated exclusively for premenopausal women with acquired, generalized HSDD. A formal diagnosis requires that:
- the reduced desire cannot be explained by another medical condition,
- it is not caused by a medication or substance,
- it causes notable personal distress or relationship difficulties.
The recommended dose is 100 mg once daily at bedtime. Taking it at night is essential to reduce the risk of dizziness and low blood pressure. Treatment effectiveness should be evaluated after approximately 8 weeks. If no improvement is observed, the medication should be discontinued.
Side Effects
Flibanserin can cause a range of adverse effects. The most commonly reported include:
- Dizziness and lightheadedness
- Somnolence and fatigue
- Nausea
- Insomnia
- Dry mouth
A particularly serious interaction exists with alcohol: concurrent use can lead to severe hypotension and loss of consciousness. Alcohol consumption is therefore strictly contraindicated during treatment. Certain medications, particularly CYP3A4 inhibitors such as fluconazole or some antibiotics, can dangerously raise flibanserin blood levels.
Contraindications
Flibanserin must not be used in patients who:
- consume alcohol
- take strong or moderate CYP3A4 inhibitors
- have liver impairment
- have low blood pressure (hypotension)
Scientific Evaluation
The clinical efficacy of flibanserin remains a topic of debate within the medical community. Clinical trials demonstrated a statistically significant but modest improvement in sexual desire and satisfying sexual events compared to placebo. Critics argue that the benefit-risk profile must be carefully considered given the potential side effects. A holistic approach that also addresses psychological and relationship factors is generally recommended alongside pharmacological treatment.
References
- U.S. Food and Drug Administration (FDA): Addyi (flibanserin) Prescribing Information. Silver Spring, MD: FDA; 2015. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/022526lbl.pdf
- Jaspers L et al. - Efficacy and Safety of Flibanserin for the Treatment of Hypoactive Sexual Desire Disorder in Women: A Systematic Review and Meta-analysis. JAMA Internal Medicine, 2016; 176(4):453-462.
- Clayton AH et al. - Flibanserin: A Potential Treatment for Hypoactive Sexual Desire Disorder in Premenopausal Women. Neuropsychiatric Disease and Treatment, 2015; 11:2421-2428.
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