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
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, 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 Jan 25 2023, 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.
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
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.
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)
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
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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