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Sexual Health
CMECNE

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

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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. Describe how bremelanotide is administered
2. Discuss contraindications, warnings and precautions in the use of bremelanotide

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 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 1/15/2020 through 07/15/2022, 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 0.1 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.

Read Disclaimer & Fine Print

CLINICAL ACTIONS:

A new treatment has been approved by the FDA for hypoactive sexual desire disorder (HSDD).  

  • HSDD: Characterized by
    • Low sexual desire
    • Marked distress or interpersonal difficulty
    • Note: Not due to a co-existing problem (e.g. medical, psychiatric, relationship issues, drug use etc.)
  • Acquired HSDD
    • No previous issues related to sexual desire are identified
  • Generalized HSDD
    • HSDD occurs regardless of type of sexual activity, situation or partner
  • Prior to prescribing this medication, consider the following to ensure that HSDD is not a symptom of a more significant medical problem
    • Obtain a thorough history and evaluation in order to diagnose HSDD (see Related ObG Topics below)
    • A general physical examination, CBC and chemistry panel

SYNOPSIS:

Bremelanotide is a melanocortin receptor agonist for the treatment of HSDD in premenopausal women. Bremelanotide is self-administered with a prefilled autoinjector pen 45 minutes before anticipated sexual activity.

KEY POINTS:

  • Dosage
    • Subcutaneous injection: 1.75 mg/0.3 mL solution (abdomen or thigh)
    • Patients should not use more than one dose within 24 hours or more than eight doses per month
  • Contraindications
    • Uncontrolled hypertension or known cardiovascular disease
    • Not recommended in patients at high risk for cardiovascular disease
    • Discontinue if pregnancy is suspected
    • Advise women of reproductive potential to use effective contraception
  • Warnings and Precautions
    • Transient increase in blood pressure and decrease in heart rate occurs after each dose and usually resolves within 12 hours
    • Consider the patient’s cardiovascular risk before initiating medication and periodically during treatment and ensure blood pressure is well-controlled
  • Commonly reported adverse reactions (incidence >4%)
    • Nausea: 40% (13% required anti-emetic)
    • Flushing: 20.3%
    • Injection site reactions: 13.2%
    • Headache: 11.3%
    • Vomiting: 4.8%
  • Concomitant behavioral and psychotherapy can be extremely helpful in the process of treatment
    • Consider simultaneous referral to sex therapist
  • Clinical trials
    • Sexual desire score (range of 1.2 to 6.0 with higher scores indicating greater sexual desire)
      • Treated patients: 25% had an increase of ≥1.2
      • Placebo: 17% had an increase of ≥1.2
  • Bremelanotide can be used in conjunction with hormone therapy

Diagnosis Codes: Sexual interest/arousal disorder: DSM-5 302.72 (F52.22)

Learn More – Primary Sources :

FDA approves new treatment for hypoactive sexual desire disorder in premenopausal women

ClinicalTrials.gov: Bremelanotide in Premenopausal Women With Female Sexual Arousal Disorder and/or Hypoactive Sexual Desire Disorder

Bremelanotide for female sexual dysfunctions in premenopausal women: a randomized, placebo-controlled dose-finding trial.

FDA: VYLEESI – Highlights of Prescribing Information

Locate a Sexual Health Professional:

AASECT-Referral Directory

ISSWSH-Find a Provider

SSTAR-Find a Therapist

Take a post-test and get CME credits

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Related ObG Topics:

A Patient Complains of Low Sexual Desire – Making an Accurate Diagnosis
Sexual Desire and Arousal: The Nonlinear Model
Treatment Options for the Patient with Sexual Arousal Concerns
Bupropion for Sexual Dysfunction
Could Flibanserin Treat Hypoactive Sexual Desire in Postmenopausal Women?
Testosterone Therapy for Low Desire – How, When and Where?

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Computer System Requirements

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.

Disclaimer

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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