Is Flibanserin Worth the Risks? — Physician’s First Watch

Medical News |
March 1, 2016

Is Flibanserin Worth the Risks?

By Andrew M. Kaunitz, MD

Dr. Kaunitz is editor-in-chief of NEJM Journal Watch Women's Health, from which this story was adapted. See full coverage at the link below.

The benefits of flibanserin (Addyi) for hypoactive sexual desire disorder in women appear to be "marginal," especially when considering the potential side effects, according to a meta-analysis in JAMA Internal Medicine.

The analysis included eight randomized trials among nearly 6000 pre- and postmenopausal women. Among the outcomes for flibanserin compared with placebo:

  • The number of satisfying sexual events per month increased by 0.5 (from a baseline of 2.5 events monthly).

  • The mean increase in a sexual desire intensity score was 1.6 (on a 0–84 scale).

  • The mean increase in desire on the Female Sexual Function Index was 0.3 (on a 1.2–6.0 scale).

These differences were statistically significant but small. Among women who received flibanserin, impressions of subjective improvement ranged from minimal to no change. Flibanserin recipients were roughly two to four times more likely to experience dizziness, somnolence, nausea, or fatigue.

Comment: Although diminished sexual desire is a common complaint, I almost never prescribe flibanserin, given its unfavorable risk/benefit profile. I agree that, for now, management of hypoactive sexual desire disorder is best served by a multidisciplinary "biopsychosocial" approach.

Reader Comments (1)

Ellen Grant MBChB, DObstRCOG Physician, Obstetrics/Gynecology, Retired

The commonest reasons for loss of libido are use of progestins which raises levels of monoamine oxidase and zinc deficiency.1,2
Oysters have high amounts of zinc and are famous for being used as aphrodisiacs.

1 Grant ECG, Pryse Davies J. Effect of oral contraceptives on depressive mood changes and on endometrial monoamine oxidase and phosphatases. Br Med J 1968;3:777-80.

2 Grant ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity, and mineral imbalance .J Nutr Environ Med 1998;8:105-116.

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