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

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?