By Fiona McMahon, DPT
When the FDA approved use of ADDYI (flibanserin) in August of 2015, it felt like the world blew up. Newspapers heralded its’ release as “female viagraâ€. Some rejoiced, “finally, gender parity in medicine for sexual dysfunction!â€, while others turned up their noses at it, questioning its necessity for women with low libido. There are a lot of emotions around this new drug and it has had an interesting effect of raising some very important questions about female sexuality, society’s comfort with sexuality at large, and gender equality. In this post, we will examine the black and white facts about this drug. We will try and push past the emotion surrounding this drug to study how it works. Ultimately, you will have to decide what this drug means to you, but hopefully this post will provide you with a brief background to how the drug effects those taking it. Let’s get started. Image via thedaonline
The first and most important question to ask is, “who is this drug for?â€. ADDYI is for premenopausal women with low desire to engage in sexual activity of any kind, alone or with any partner. Women who are appropriate to take ADDYI are women who do not experience low sexual desire secondary to relationship problems, drug use (prescription or otherwise), or mental illness like depression (which can affect one’s sexual desire).
ADDYI works by enhancing the activity of serotonin receptors in your brain and is classified as an antidepressant. It does not work like Viagra, which affects the blood supply in a man’s penis, allowing it to enlarge with sexual drive. ADDYI helps a woman gain the sexual drive that a man who is taking Viagra already has–it does not directly work on a woman’s genitals. ADDYI and Viagra act differently to help with sex. One, (Viagra) prepares the sexual organs of someone who has the desire to have sex to engage in sexual activity, while the other (ADDYI) contributes to sexual drive. When someone refers to ADDYI as the “female Viagra†they are not being totally accurate. Both drugs help with sexual issues, but beyond that, the similarities end.
ADDYI, unfortunately is not appropriate for everyone. ADDYI is not for the treatment of low sexual desire in women who have gone through menopause or for men. ADDYI does not enhance sexual performance, rather it restores drive to a woman with low sexual desire.
When we ingest any drug, be it a prescribed pharmaceutical like ADDYI, or a supplement like magnesium for constipation, we have to expect that the drug may have effects outside of the ones we intended. ADDYI, although it is effective, it comes with some potentially serious side effects.
ADDY, in some cases, can cause a potentially serious drop in blood pressure (hypotension), which can lead to fainting and potential injury. The risk of this serious blood pressure drop is increased with the use of alcohol. If you are on ADDYI you cannot enjoy a sexy little glass of champagne before getting it on because of the risk of fainting.The risk factors associated with drinking alcohol with ADDYI are so serious that prescribers and pharmacists must take a Risk Evaluation and Mitigation Strategy (REMS) before ADDYI can be dispensed to patients to ensure that their patients are indeed capable of abstaining from alcohol.
ADDYI is also contraindicated with a number of other drugs. ADDYI cannot be used in individuals who are currently on certain antifungals such as diflucan and others, treatment for HIV-1 infection, taking certain blood pressure medicines, or people with liver problems as this can also increase your risk for fainting/ injury.
ADDYI also causes central nervous system depression. What this means is that it can make you really sleepy. In the prescribing information released by Sprout Pharmaceuticals, the manufacturers of ADDYI, tell the prescriber to instruct their patients to take ADDYI only before bedtime and to avoid driving or other tasks that require alertness for 6 hours following taking ADDYI.
The next question we have to ask about ADDYI is does it actually work? A study conducted by Katz and colleagues found that ADDYI did have a significant effect on sexual desire in women. Katz and her colleagues also observed the same side effects mentioned above. These side effects lead to 9.6% of the study participants to discontinue ADDYI.
After doing the research for this blog, I gained greater insight into this medication ADDYI is not some riskless drug that can magically make you into a lady Casanova. We have to keep in mind, with any pharmaceutical there can be enormous benefits, like the return of sexual drive, but there are unattended side effects. Luckily, with the availability of information out there and with the guidance of your doctor you can decide if pursuing ADDYI is right for you.
Female sexuality and arousal is a complex subject and there may be alternatives to ADDYI if you are someone who cannot safely take it. Sex is an important part of life for women and there are many different reasons sex may be difficult, not desired, or even painful. ADDYI is not a magic bullet, but another tool (to be used judiciously) in our thankfully growing toolbox to treat female sexual dysfunction.
Sources:
Highlights of Prescribing Information. http://www.accessdata.fda.gov/drugsatfda_docs/label/2015/022526lbl.pdf. Reference ID:3808140
Katz M, DeRogatis L, Ackerman R, et al. Efficacy of flibanserin in women with hypoactive sexual desire disorder: Results from the BEGONIA Trial. International Society for Sexual Mediceine. 2013
