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

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Identify the appropriate candidate and use for the drug
2. Explain those steps needed to prescribe the medication

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty: Susan J. Gross, MD, receives consulting fees from Genoox, Inc., and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2019, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Designated for 0.2 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.

Read Disclaimer & Fine Print

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