Flibanserin (Addyi): Everything You Need to Know

Flibanserin (Addyi) is a prescription drug used to treat hypoactive sexual desire disorder (HSDD) in premenopausal women.

It’s often referred to as “female viagra” — but this isn’t accurate, for reasons we’ll explore throughout this article.

This little pink pill is said to stimulate sexual desire in women and has been getting a lot of mixed reviews lately. Some women swear by it — while other reports have shown an average of only 0.5 additional “satisfying sexual events” per month after starting the drug.

Does Addyi really work?

Learn everything you need to know about where to buy Addyi, how to use it safely, and when to avoid it completely. 

What is Addyi (Flibanserin)?

Addyi is the only medication that’s been approved for the treatment of HSDD in women.

HSDD has been recognized as an official disorder for the last 30 years. Despite how long we’ve known about the condition, there’s been surprisingly little development for medications to treat the disorder.

Addyi was the first drug developed to treat the condition, and even this medication struggled to gain approval from the FDA. Questions surrounding the need for the drug, along with its risk to benefit ratio lead the FDA to deny approval to sell the drug in 2010.

It wasn’t until numerous follow-up clinical trials and campaigns from women’s advocacy groups that the drug was finally approved for sale.

The only version of flibanserin available today is the brand name version called Addyi, which is only available in the United States. There are also no generic versions of this medication currently available and the patents protecting the drug from competition remain valid until 2035.

Is Addyi Female Viagra?

Comparing Addyi to Viagra is like comparing apples to oranges. Yes, they’re both used to regulate sexual health, but they act on completely different aspects of sexual health and are used in a completely different manner.

Addyi is serotonergic — which means it alters the balance of serotonin levels in the brain. Viagra, in comparison, inhibits an enzyme in the penis that helps widen blood vessels to produce an erection.

Addyi targets the brain to address sexual desire — Viagra targets the penis and has no effect on sexual desire.

Secondly, Addyi needs to be used every day to be effective, whereas Viagra is used on an as-needed basis.

So no, Addyi is not the female version of Viagra.

What’s The Dose of Addyi?

Addyi only comes in one dose — 100 mg taken daily right before bed.

It’s important women use Addyi on a daily basis for it to work. This drug doesn’t work on a case-by-case basis — meaning women need to use the drug consistently for it to work.

Technically, this medication can be used at any time in the day, but side effects involving low blood pressure and dizziness are very common. This is why the official prescription protocol for this medication is to use the drug before bed when these side effects pose the least amount of risk or discomfort.

How Long Does it Take For Flibanserin to Work?

Flibanserin is quickly absorbed through the intestinal tract, but the benefits of the drug take several days or weeks of regular use before they’re noticeable.

Unlike other sexual health medications like Viagra, Addyi needs to reach a steady-state to be effective. This involves taking the drug consistently at the same time every day until levels of the drug in the bloodstream remain stable. This is a similar approach used for other medications that work through serotonin such as antidepressants.

It takes about 3 days to reach a steady-state with Addyi, and about a week before any noticeable changes in sexual desire become noticeable [4].

How Much Does Addyi Cost?

Addyi is a relatively expensive drug — costing users around $830 for a 1 month supply.

This price is determined based on the cost to develop the drug combined with the number of patients who actually need the drug — fewer people using medication mean the cost has to be higher to cover the investment made during development.

Compared to other sexual health medications (such as Viagra or Cialis for men), the cost per pill is on-par. The difference with Addyi is that the drug needs to be taken on a daily basis rather than on an as-needed basis — making this drug much more expensive long-term.

The History of Addyi & Flibanserin

Flibanserin was first developed in 2010 by Boehringer Ingelheim — a large multinational pharmaceutical company based out of Germany. The company started developing the drug with the intention of producing a new antidepressant. The medication works through serotonin receptors in the brain, which is a common target for antidepressant medications.

After it was discovered the drug was ineffective for managing clinical depression, the company shifted focus and started testing new applications for the drug. It was discovered that the specific serotonin receptors flibanserin target play a key role in the arousal process.

After a few years of development, Boehringer Ingelheim applied for approval for their new drug with the FDA. The approval was officially denied in 2010. The reason cited was an inadequate risk to benefit ratio from using the drug.

The development of flibanserin came to a halt for a few years before it was sold to Sprout Pharmaceuticals. Sprout conducted another phase III clinical trial on the drug and a series of drug-drug interaction studies.

Additionally, a few women’s advocacy groups in the United States signed a petition put forward by a coalition dubbed “Even the Score” to push approval of the drug. The argument used a feminist approach — ”if men have medications for sexual health, women should have that right too”.

This played a major role in the eventual approval of the medication by the FDA in 2015 — but it’s not without controversy. The coalition itself was funded by Sprout Pharmaceuticals — the very force behind the drug itself. Of course, their interests are skewed towards earning approval for the drug.

Some have argued that feminism itself was reason enough to object to Addyi. “How can it be feminist for doctors to tell women what’s normal and prescribe pills to control their sexual desire?”

Controversy aside, the coalition worked, and the drug was approved for sale in the United States in 2015.

Less than a month after the drug’s approval, Sprout Pharmaceuticals was bought by Valeant Pharmaceuticals for $1 billion cash. Valeant now owns exclusive rights to manufacture and sell the medication.

Today, the brand name flibanserin, Addyi, is protected by patent laws. This means there are no generic open-market versions of this drug available until at least 2035.

What is Addyi Used For?

Addyi is used for women diagnosed with hypoactive sexual desire disorder (HSDD). This condition is considered the most common female sexual dysfunction — affecting an estimated 10% of women in the United States [3].

There’s a lot of debate about whether Addyi is a good option for women diagnosed with HSDD or not. Some women report marked improvements in sexual desire after using the drug, but the drug also brings considerable risk.

If you’re experiencing problems with sexual desire, speak with your doctor to see if Addyi is right for you, or not.

What is Hypoactive Sexual Desire Disorder (HSDD)

HSDD is characterized by a persistent absence of sexual desire for sexual activity. A doctor will only diagnose HSDD if these symptoms are a major cause of distress in a woman’s life. Before a diagnosis is made, doctors will try to rule out any underlying causes — such as depression, substance abuse, or other underlying medical conditions.

In simple terms, HSDD is a condition involving long-term low-libido resulting in emotional distress.

HSDD is non-life-threatening, but can severely affect mental health and wellbeing [4].

This condition was officially removed from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorder (DSM-V) — a journal published by the American Psychiatric Association that catalogs and describes the current state of understanding of mental health diagnosis.

In the most recent edition, HSDD was converted into a set of criteria for assessing female sexual interest (FSI).

For the sake of diagnosis and prescription of flibanserin, HSDD is still classified as a medical condition by The American College of Obstetricians and Gynecologists (ACOG).

Is Addyi (Flibanserin) Safe?

The safety of flibanserin is hotly debated. The risk of side effects is relatively high — roughly one in six women using this drug experienced severe dizziness and low blood pressure [5]. One in eight patients stopped taking the drug because of these side effects.

The chances of experiencing side effects are so high, doctors recommend taking the drug right before bed when the side effects are less troublesome. The impact these effects have on the quality of sleep has not been studied.

The safety profile of Addyi while pregnant or breastfeeding remains unknown.

The chances of experiencing side effects from Addyi are significantly higher in combination with alcohol or certain medications (more on this below).

Side Effects of Addyi Include

  • Dizziness (11.4%)
  • Drowsiness (11.2%)
  • Nausea (10.4%)
  • Fatigue (9.2%)
  • Insomnia (4.9%),
  • Dry mouth (2.4%)

Flibanserin Drug Interactions

Like most medications, flibanserin may interact negatively with other substances or medications.

1. Alcohol

The most common drug interaction with flibanserin is alcohol. This medication needs to be used on a daily basis to be effective, which means women can’t drink alcohol whatsoever when taking this medication.

Mixing alcohol with flibanserin dramatically increases the chances of experiencing side effects such as low blood pressure, dizziness, and drowsiness. If blood pressure drops too low it can lead to fainting spells.

2. CYP3A4 Inhibitors

Most medications need to be metabolized (disassembled) by enzymes in the liver before they can be removed from the body. A special group of enzymes called the CYP450 isoenzymes are tasked with breaking down different compounds.

There are many different types of these enzymes, in the liver, each specializing in breaking apart a specific type of molecule.

Flibanserin, along with many other drugs, are metabolized by the CYP3A4 enzymes in the liver.

If other medications or substances are taken at the same time as flibanserin they’ll compete for metabolism by the 3A4 enzymes. When this happens, flibanserin can gradually start to accumulate in the body — leading to side effects.

3. Blood Pressure Medications

The most common side effect of flibanserin is low blood pressure. If this drug is used alongside other blood pressure medications, they can have a compound effect — causing blood pressure to drop too low.

How Does Addyi (Flibanserin) Work?

Flibanserin works by inhibiting and stimulating different serotonin receptors in the brain.

More specifically, flibanserin activates the 5HT1A serotonin receptors and blocks the 5HT2A receptors [6].

So how does this affect libido?

Sexual arousal is a very complicated process. It relies on the interaction of several different neurotransmitters and regions of the brain. Neurotransmitters involved in the process include dopamine, serotonin, prolactin, and norepinephrine.

Imbalances with any of these neurotransmitters, along with other factors like hormone levels, and sexual attraction to a partner can all affect sexual desire.

If dopamine levels are too low, or serotonin too high, it can lead to a loss of libido. This is thought to be one of the main underlying causes of HSDD in women. It’s also the primary mechanism flibanserin uses to treat the condition.

This drug acts on the serotonin receptors in the prefrontal cortex of the brain. These receptors trigger the release of dopamine and norepinephrine and inhibition of serotonin release [6,7,8].

The specificity of this drug for shifting the balance of dopamine and serotonin in the brain, and an all-around lack or interaction with other neurotransmitters involved with the arousal process is likely why this medication has such a low success rate.

Addyi Alternatives

There is only one direct alternative to Addyi in the treatment of HSDD — a drug called Vyleesi (bremelanotide).

There are also plenty of other nutritional, non-prescription, and lifestyle treatments available for managing the condition instead. There are alsoa few options available for treating some of the potential underlying cause for the condition — such as hormone imbalance.

Here are three alternative options to Addyi to consider:

1. Vyleesi (bremelanotide)

Vyleesi was only recently approved by the FDA for the treatment of HSDD in women. This drug works differently than Addyi, by activating the melanocortin receptors. It’s injected in the thigh about 45 minutes before sexual activity.

Unlike Addyi, Vyleesi is used on an as-needed basis, with a maximum of once per 24 hours and 8 times per month.

2. Hormone Therapy

Female sex hormones such as estrogen and progesterone play a key role in the regulation of the female reproductive system — including sexual desire and libido. Male androgens are also important for stimulating sexual desire in women.

Low estrogen can lead to a loss of libido, as well as vaginal dryness. This can make intercourse painful and make it less desirable for women to engage in sexual activity.

Studies have shown a treatment protocol of both estrogen and androgen hormone replacement therapies together has the greatest impact on libido in women [9].

3. Lovegra

Lovegra is a generic version of sildenafil citrate — which is the same active ingredient in Viagra. It’s made by Ajanta Pharmaceuticals, which advertises the drug as a treatment for FSAD (female sexual arousal disorder), which is a closely related condition to HSDD.

This drug has not been approved in the United States or Europe.

Where to Buy Addyi (Flibanserin)

In order to get your hands on this “little pink pill”, you’ll need to get a prescription from your doctor.

On the website itself, you can go through the process of getting Addyi by filling out an online screening survey, and booking a call with one of the company’s associated medical professionals.

The appoinment to see a doctor costs $20 through an online video call. They will assess whether Addyi is a good option for you or not.

Once you’ve got a prescription, you can order Addyi directly through the links provided after your consultation. The cost of the first month of Addyi is just $20, but can cost substantially more after the first month trial is over.

References Cited in This Article

  1. McCartney, M. (2015). Margaret McCartney: Flibanserin for low sexual desire is not feminism. Bmj, 351, h5650.
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  3. Shifren, J. L., Monz, B. U., Russo, P. A., Segreti, A., & Johannes, C. B. (2008). Sexual problems and distress in United States women: prevalence and correlates. Obstetrics & gynecology, 112(5), 970-978.
  4. Biddle, A. K., West, S. L., D’Aloisio, A. A., Wheeler, S. B., Borisov, N. N., & Thorp, J. (2009). Hypoactive sexual desire disorder in postmenopausal women: quality of life and health burden. Value in Health, 12(5), 763-772.
  5. US Food and Drug Administration. (2015). FDA briefing document: Joint meeting of the bone, reproductive and urologic drugs advisory committee (BRUDAC) and the drug safety and risk management (DSaRM) advisory committee. Silver Spring, MD: US Food and Drug Administration.
  6. Stahl, S. M. (2015). Mechanism of action of flibanserin, a multifunctional serotonin agonist and antagonist (MSAA), in hypoactive sexual desire disorder. CNS spectrums, 20(1), 1-6.
  7. Woodard, T. L., Nowak, N. T., Balon, R., Tancer, M., & Diamond, M. P. (2013). Brain activation patterns in women with acquired hypoactive sexual desire disorder and women with normal sexual function: a cross-sectional pilot study. Fertility and sterility, 100(4), 1068-1076.
  8. Arnow, B. A., Millheiser, L., Garrett, A., Polan, M. L., Glover, G. H., Hill, K. R., … & Buchanan, T. (2009). Women with hypoactive sexual desire disorder compared to normal females: a functional magnetic resonance imaging study. Neuroscience, 158(2), 484-502.
  9. AlAwlaqi, A., Amor, H., & Hammadeh, M. E. (2017). Role of hormones in hypoactive sexual desire disorder and current treatment. Journal of the Turkish German Gynecological Association, 18(4), 210.

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