GYN
CMECNE

Prescribing Flibanserin for Low Desire: How, When and Where?

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Learning Objectives and CME/Disclosure Information

CLINICAL ACTIONS:

Medical treatment is available for low sexual desire (HSDD). Typically, a general physical examination, CBC and chemistry panel can ensure that the low libido is not a symptom of a more significant medical problem.

    • Depression screening should be performed
    • Rule out general medical illnesses or surgical causes
    • Differentiate low desire, the indication for this medication, from low arousal
    • Flibanserin can be given concomitantly with hormone treatment

SYNOPSIS:

Flibanserin has been shown to increase sexual desire in women. Any prescription of flibanserin should follow a thorough history-taking evaluation. Management often requires a multimodal approach and therefore consistency and efficacy may be improved with associated behavioral therapy.

KEY POINTS:

    • Obtain a thorough history and evaluation in order to diagnose low libido
    • Daily dosage is 100 mg daily and should be taken before bed as it can make patients drowsy
    •  The black box FDA warning was changed (October 2019)
      • Alcohol is no longer a contraindication
      • Risk Evaluation and Mitigation Strategy (REMS) distribution restrictions have been removed
    • Consider registering to receive drug company coupons when available, as the drug may be prohibitively expensive without them
    • Concomitant behavioral and psychotherapy can be extremely helpful in the process
  • Concomitant behavioral therapy and psychotherapy may be helpful in the process
    • Consider simultaneous referral to sex therapist while treating the patient
  • Diagnosis Codes: Sexual interest/arousal disorder: DSM-5 302.72 (F52.22)

Adverse Events

  • Although alcohol is not contraindicated, patients should be made aware that
    • Flibanserin and alcohol increases the risk of severe hypotension and syncope
    • Women should discontinue drinking alcohol at least two hours before taking flibanserin at bedtime or to skip the flibanserin dose that evening
    • If ingesting 3 or more drinks, dose should be skipped that evening
    • Women should not consume alcohol at least until the morning after taking flibanserin at bedtime
  • Flibanserin is contraindicated in patients with hepatic impairment or using strong or moderate CYP3A4 inhibitors (list of contraindicated medications can be found in the ‘Learn More – Primary Sources’ using the Medication Guide link | Include medications to treat HIV, fungal infections and some antibiotics)
    • Severe hypotension and syncope can occur when  used in these settings
  • Not recommended for use during pregnancy or if breastfeeding

Learn More – Primary Sources:

Flibanserin and Female Sexual Desire

Flibanserin for Treating Hypoactive Sexual Desire Disorder

Flibanserin for hypoactive sexual desire disorder: place in therapy

ISSWSH Expert Consensus Panel Review: Hypoactive Sexual Desire Disorder 

FDA: ADDYI Highlights of Prescribing Information 

FDA: Medication Guide for Addyi 

Locate a Sexual Health Professional:

AASECT-Referral Directory 

ISSWSH-Find a Provider 

SSTAR-Find a Therapist

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