Gynecology Book

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Addyi

Aka: Addyi, Flibanserin
  1. See Also
    1. Female Sexual Dysfunction
  2. Indications
    1. Hypoactive sexual drive in women (libido)
  3. Mechanism
    1. Serotonin Agonist-antagonist
    2. Does not increase sexual organ blood flow (unlike Phosphodiesterase Inhibitors such as Viagra)
  4. Dosing
    1. One tablet daily at bedtime
  5. Efficacy
    1. Premenopausal women may experience 1 more satisfying sexual encounter in 1-2 months (NNT 11)
    2. Only effective if consistently taken daily (and may take 8 weeks of continuous use for full effect)
  6. Adverse Effects
    1. Hypotension (especially in liver disease, when taken with Alcohol or when taken with CYP3A4 Inhibitor)
      1. Systolic Blood Pressure dropped >50 mmHg in some cases when combined with Alcohol (NNH 6)
  7. Disadvantages
    1. Marginal efficacy in premenopausal women (and less effective in postmenopausal women)
    2. Expensive ($350/month)
    3. Severe Hypotension may occur (esp. with Alcohol, CYP3A4 inhibitors)
    4. Prescribers must undergo REMS training before prescribing
      1. http://www.accessdata.fda.gov/scripts/cder/rems/index.cfm?event=IndvRemsDetails.page&REMS=350
  8. Drug Interactions
    1. CYP3A4 inhibitors (e.g. Fluconazole, Grapefruit)
      1. Avoid CYP3A4 inhibitors for 2 weeks before starting Addyi and for 2 days after stopping
      2. Single dose of a strong CYP3A4 inhibitor could significantly raise Addyi doses with Hypotension risk
  9. References
    1. (2015) Presc Lett 22(10):60

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