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If you’re frustrated because it feels like you’re never in the mood for sex, you’re not alone. 10% to 40% of women struggle with their libidos due to a medical disorder called hypoactive sexual desire disorder (HSDD), also known as female sexual interest/arousal disorder (Jaspers, 2016). With HSDD, you have a low sexual desire that’s stressful or frustrating but isn’t related to any tangible underlying cause (such as a side effect of a medication that you take or an underlying medical or mental health condition)
Addyi (flibanserin) is a prescription drug that healthcare providers sometimes prescribe to premenopausal women with HSDD to boost sexual desire. Read on to learn more about flibanserin and why a healthcare provider may recommend it for you.
What is Addyi (flibanserin)?
Addyi—or the “little pink pill”—is a prescription drug that helps treat low sexual desire in pre-menopausal women. It was approved by the Food and Drug Administration (FDA) in 2015 and is available in a 100-milligram oral tablet that is usually taken once a day at bedtime (FDA, 2021).
Addyi goes by the nickname “the female Viagra”—but Viagra and Addyi are not the same. Viagra (sildenafil; see Important Safety Information) is FDA-approved to treat erectile dysfunction in men. Healthcare providers sometimes prescribe sildenafil off-label to women with sexual dysfunction (that includes problems with arousal and orgasm, as well as pain during sex). Still, the data on the effectiveness of sildenafil for women is mixed.
Sexual desire, especially in women, is a complex thing that’s both physical and emotional. Addyi is different from Viagra because Addyi is thought to work in the brain, where it helps with the emotional side of sexual desire.
Addyi uses and benefits
Healthcare providers prescribe Addyi (flibanserin) to boost sexual desire in those with hypoactive sexual desire disorder (HSDD) who haven’t been through menopause. HSDD is also often referred to as female sexual interest/arousal disorder (FSIAD) because of the overlap between desire and arousal.
Addyi isn’t FDA-approved for men or for people who have already undergone menopause. It also does not improve sexual performance (FDA, 2021).
Addyi (flibanserin) side effects
Not everyone who takes Addyi has side effects. However, you may be more vulnerable to side effects if you have liver problems, take certain medications, or drink alcohol with Addyi (FDA, 2021). (For more details, see the “Addyi warnings” section below.)
Addyi’s most common side effects include (FDA, 2021):
- Trouble falling asleep or staying asleep
- Dry mouth
Less frequently, people experience other adverse effects such as:
- Severe hypotension (very low blood pressure), which may lead to syncope (passing out or loss of consciousness)
- Stomach pain
- Vaginal bleeding between periods
Because of these potential side effects, you shouldn’t drive after taking Addyi. If you feel dizzy, it’s best to lie down. Call a healthcare provider or seek medical attention if the feeling doesn’t go away or becomes severe.
While taking Addyi, it’s very important to keep track of when and how much alcohol you drink. The FDA has a boxed warning for the drug’s effects with alcohol use. This is because alcohol can interact with Addyi, increasing your risk for low blood pressure and syncope (passing out or loss of consciousness) (FDA, 2021).
When it comes to alcohol and Addyi, the FDA recommends:
- If you have one or two servings of alcohol, you should wait at least two hours before you take Addyi that evening at bedtime.
- If you consume three or more servings of alcohol, you should skip your dose of Addyi that evening.
- After taking a dose of Addyi at bedtime, you should not have any alcoholic drinks until the following day.
Not sure what counts as a serving of alcohol? According to the Centers for Disease Control and Prevention (CDC), a standard serving of alcohol is 12 ounces of beer (5% alcohol), 8 ounces of malt liquor (7% alcohol), 5 ounces of wine (12% alcohol), or 1.5 ounces of liquor such as vodka (40% alcohol) (CDC, 2021):
Besides alcohol, certain medicines can interact with Addyi, potentially raising your risk for serious side effects. Some examples include:
- Hormonal contraceptives like birth control pills
- Fluconazole (Diflucan), an antifungal drug used to treat yeast infection
- Drugs that cause drowsiness, such as antihistamines (like diphenhydramine), opioids (such as oxycodone or heroin), hypnotics (like zolpidem), and benzodiazepines (such as alprazolam and diazepam)
- Blood pressure medications like diltiazem and verapamil
- Digoxin, a heart medication
- Antidepressants like selective serotonin reuptake inhibitors (SSRIs)
- Proton pump inhibitors (PPIs) for acid reflux, such as omeprazole
Additionally, some herbs and foods can interact with Addyi. A few examples are ginkgo, St. John’s wort, and grapefruit (FDA, 2021).
It’s best not to assume that any medication is safe with Addyi without first consulting your healthcare provider.
Addyi (flibanserin) warnings
Addyi may not be safe for everyone. Before prescribing Addyi, your healthcare provider will go over your medical history, such as any medical conditions you have. You’ll want to make sure to tell them if you are pregnant or breastfeeding or if you have (or had) trouble controlling the amount of alcohol you drink, liver problems, or an allergic reaction to Addyi (flibanserin) or its ingredients (FDA, 2021)
If you’re feeling stressed about your low sex drive, talk to your healthcare provider to see if a drug like Addyi is right for you.
- Centers for Disease Control and Prevention (CDC). (2021). Alcohol use and your health. Retrieved Jan. 31, 2022 from https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm
- Jaspers, L., Feys, F., Bramer, W. M., Franco, O. H., Leusink, P., & Laan, E. T. (2016). Efficacy and safety of flibanserin for the treatment of hypoactive sexual desire disorder in women: a systematic review and meta-analysis. JAMA Internal Medicine, 176(4), 453–462. doi: 10.1001/jamainternmed.2015.8565. Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2497781
- U.S. Food and Drug Administration (FDA). (2021). Addyi (flibanserin) tablets for oral use. Retrieved Jan. 31, 2022 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/022526s010lbl.pdf
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.