How Does Addyi Work?
The exact mechanism of action by which Addyi increases sexual desire in women with HSDD is unknown.2
Preclinical studies have shown that flibanserin is a highly selective postsynaptic serotonin (5HT)1A antagonist and 5HT2A antagonist and may also act as an antagonist at 5HT2C and 5HT2B receptors and dopamine D4 receptors.2,24
Collectively, these effects are believed to increase dopamine and norepinephrine, and transiently decrease serotonin, to restore the appropriate balance of excitatory and inhibitory activity of brain reward centers to the prefrontal cortex.24
How long will it take to feel the effects of Addyi?
In clinical trials, improvements in HSDD symptoms (increase in sexual desire, increase in satisfying sexual events, decrease in associated distress) were observed as early as 4 weeks after starting Addyi. Not all women will experience similar improvement in their HSDD.2
Improvements can be subtle at first, with gradual improvement. It is important to follow up with women prescribed Addyi to discuss improvements in their HSDD symptoms. Addyi should be discontinued if there is no improvement after 8 weeks.2
Is it safe to drink alcohol and take Addyi?
Taking Addyi within two hours after consuming alcohol increases the risk of severe hypotension and syncope. To reduce this risk, counsel patients to wait at least two hours after drinking one or two standard alcoholic drinks* before taking Addyi at bedtime. Counsel patients who drink three or more standard alcoholic drinks to skip their Addyi dose that evening. After taking Addyi at bedtime, advise patients to not use alcohol until the following day.2
*One standard alcoholic drink contains 14 grams of pure alcohol and is equivalent to one 12-ounce regular beer (5% alcohol), 5-ounces wine (12% alcohol), or 1.5 ounces of distilled spirits/shot (40% alcohol).
Is Addyi a hormonal medication?
Addyi is not a hormone or a hormonal treatment. Addyi is a centrally acting multifunctional serotonergic agonist and antagonist. Based on findings from preclinical studies, it is thought that Addyi transiently decreases serotonin activity and increases dopamine and norepinephrine activity to restore an appropriate balance of excitatory and inhibitory activity of the brain reward centers to the prefrontal cortex. The precise mechanism of action by which Addyi enhances sexual desire in women with hypoactive sexual desire remains unknown.24
Will my patients’ desire go away if they stop taking Addyi?
Addyi is taken once daily at bedtime to treat hypoactive sexual desire disorder (HSDD) symptoms. Addyi is not a cure for HSDD. Women who experienced improvements in their HSDD symptoms, including an increase in sexual desire, a decrease in associated distress, and an increase in satisfying sexual events, may notice that their symptoms return once they stop taking Addyi.25
Do I need to taper? Are there any withdrawal effects?
Patients who want to stop taking Addyi do not need to taper their Addyi tablets. Abrupt discontinuation of Addyi is not associated with withdrawal symptoms.
During a randomized trial in 738 premenopausal women with HSDD, adverse events associated with withdrawal from CNS medications (specifically serotonergic medications) were compared among women who had taken Addyi for 48 weeks vs women who had taken Addyi for 24 weeks followed by placebo for 24 weeks. No evidence of withdrawal reactions was observed following the abrupt discontinuation of flibanserin after 24 or 48 weeks of treatment.25
What are the side effects?
The most common adverse reactions occurring in more than 2% of premenopausal women with hypoactive sexual desire disorder treated with Addyi 100 mg at bedtime (n=1543) and at a higher incidence than with placebo (n=1556), during the randomized, double-blind, placebo-controlled clinical trials, were dizziness (11.4%), somnolence (11.2%), nausea (10.4%), fatigue (9.2%), insomnia (4.9%), and dry mouth (2.4%). Most of these adverse reactions began within the first 14 days of starting Addyi.
Less common adverse reactions occurring in ≥1% but <2% of Addyi-treated women and at a higher incidence than with placebo during these clinical trials include anxiety (1.8%), constipation (1.6%), abdominal pain (1.5%), metrorrhagia (1.4%), rash (1.3%), sedation (1.3%) and vertigo (1%).2
What are the long term side effects of Addyi?
Most clinical studies of premenopausal women with hypoactive sexual desire disorder (HSDD) evaluated 24 weeks of Addyi treatment. However, one long-term safety study looked at the safety of various doses of flibanserin (N=1723) over an extended 52-week treatment period. During this study, 883 women took the FDA-approved Addyi 100 mg dose for ≥180 days.
The most common adverse events reported during the 52-week study were similar to those observed in the 24-week studies, including somnolence (15.8%), sedation (1.6%), fatigue (7.6%), dizziness (6.9%), nausea (6.3%) and vomiting (1.4%). The most common adverse events leading to early study discontinuation included depression (1.1%), anxiety (0.9%), dizziness (0.8%), fatigue (0.7%), and insomnia (0.6%).26
Do patients gain weight while taking Addyi?
Taking Addyi once daily at bedtime is not associated with weight gain.
In the clinical trials for Addyi, body weight was measured at the beginning and during the 24-week study period to assess weight changes. Among women enrolled in these clinical trials, weight gain ≥7% at the end of the study compared to when they started the study occurred in 1.8% of Addyi-treated women compared to 3.4% of women who received placebo.9
Additional information regarding weight changes can be found here
How much does Addyi cost?
Don’t be confused by sites like GoodRx, who continue to post potentially misleading pricing information about Addyi. Addyi is only $20/mo* with insurance coverage and is covered by most major insurance plans. Without insurance Addyi is never more than $149/mo* (you can even bundle 3 months for the price of 2)
*Eligible patients only. Restrictions apply. Please see Terms and Conditions at addyi.com/savings.
Is Addyi covered by insurance?
Addyi is covered by most major insurance plans. With our copay program, eligible patients can get Addyi for as little as $20/month with insurance coverage.
Without insurance, Addyi is never more than $149/month (you can even bundle 3 months for the price of 2)
What are the drug interactions with Addyi?
Clinically Significant Drug Interactions with Addyi2
Stay Up To Date on the Latest Addyi Info
IMPORTANT SAFETY INFORMATION INCLUDING BOXED WARNING AND INDICATION
IMPORTANT SAFETY INFORMATION INCLUDING BOXED WARNING AND INDICATION
- Moderate or strong cytochrome P450 3A4 (CYP3A4) inhibitors
- Hepatic impairment
- Known hypersensitivity to ADDYI or any of its components. Reactions, including anaphylaxis, reactions consistent with angioedema, pruritus, and urticaria have been reported.
Warnings and Precautions
- Hypotension and Syncope Due to an Interaction with Alcohol: Taking ADDYI within two hours after consuming alcohol increases the risk of severe hypotension and syncope. To reduce this risk, counsel patients to wait at least two hours after drinking one or two standard alcoholic drinks before taking ADDYI at bedtime. Patients who drink three or more standard alcoholic drinks should skip their ADDYI dose that evening. After taking ADDYI at bedtime, advise patients to not use alcohol until the following day.
- Hypotension and Syncope with CYP3A4 Inhibitors: Moderate or strong CYP3A4 inhibitors significantly increase ADDYI concentrations, which can lead to hypotension and syncope. Concomitant use of ADDYI with a moderate or strong CYP3A4 inhibitor is contraindicated. Concomitant use of multiple weak CYP3A4 inhibitors that may include herbal supplements (e.g., ginkgo, resveratrol) or non-prescription drugs (e.g., cimetidine) could also lead to clinically relevant increases in flibanserin concentrations that may increase the risk of hypotension and syncope.
- Central Nervous System (CNS) Depression (e.g., Somnolence, Sedation): Can occur with ADDYI alone and is exacerbated by other CNS depressants including alcohol, and in settings where flibanserin concentrations are increased such as CYP3A4 inhibitors. The risk of CNS depression is also increased if ADDYI is taken during waking hours. Patients should avoid activities requiring full alertness (e.g., operating machinery or driving) until at least six hours after each dose and until they know how ADDYI affects them.
- Hypotension and Syncope with ADDYI Alone: The use of ADDYI – without other concomitant medications known to cause hypotension or syncope – can cause hypotension and syncope. The risk of hypotension and syncope is increased if ADDYI is taken during waking hours or if higher than the recommend dose is taken. Consider the benefits of ADDYI and the risks of hypotension and syncope in patients with pre-existing conditions that predispose to hypotension. Patients with pre-syncope should immediately lie supine and promptly seek medical help if symptoms do not resolve. Prompt medical attention should also be obtained for patients who experience syncope.
- Syncope and Hypotension in Patients with Hepatic Impairment: Any degree of hepatic impairment significantly increases flibanserin concentrations, which can lead to hypotension and syncope. ADDYI is contraindicated in patients with hepatic impairment.
- Hypersensitivity Reactions: Reactions including anaphylaxis, reactions consistent with angioedema, pruritus, and urticaria have been reported with ADDYI. Immediately discontinue ADDYI and initiate appropriate treatment if hypersensitivity reaction occurs.
- Alcohol: coadministration of ADDYI with alcohol increased the risk of hypotension, syncope, and CNS depression compared to the use of ADDYI alone or alcohol alone. Patients should wait at least two hours after consuming one or two standard alcoholic drinks before taking ADDYI at bedtime or to skip their ADDYI dose if they have consumed three or more alcoholic drinks that evening.
- CNS Depressants: (i.e., diphenhydramine, opioids, hypnotics, benzodiazepines, etc.) Concomitant use with ADDYI may increase the risk of CNS depression compared to use of ADDYI alone.
- Moderate or Strong CYP3A4 Inhibitors: ADDYI is contraindicated in women taking moderate (e.g., fluconazole, etc.) or strong (e.g., ketoconazole, etc.) CYP3A4 inhibitors
- Oral Contraceptives and Other Weak CYP3A4 Inhibitors: In combination with ADDYI may increase the risk of adverse reactions
- Strong CYP2C19 Inhibitors: (i.e., proton pump inhibitors, SSRI’s, benzodiazepines, antifungals, etc.) Increase flibanserin exposure which may increase risk of hypotension, syncope, and CNS depression
- CYP3A4 Inducers: (i.e., carbamazepine, phenobarbital, etc.) Concomitant use substantially decreases flibanserin exposure compared to the use of ADDYI alone and is not recommended.
- Digoxin or other P-glycoprotein (P-gp) substrates: Increases digoxin concentration, which may lead to digoxin toxicity. Increase monitoring of drugs transported by P-gp that have a narrow therapeutic index.
Most Common Adverse Reactions
- Most common adverse reactions (ADDYI incidence ≥2% and higher than placebo) are dizziness, somnolence, nausea, fatigue, insomnia, and dry mouth.
ADDYI (flibanserin) is indicated for the treatment of premenopausal women with acquired, generalized hypoactive sexual desire disorder (HSDD) as characterized by low sexual desire that causes marked distress or interpersonal difficulty and is NOT due to:
- A co-existing medical or psychiatric condition,
- Problems within the relationship, or
- The effects of a medication or other drug substance.
Acquired HSDD refers to HSDD that develops in a patient who previously had no problem with sexual desire. Generalized HSDD refers to HSDD that occurs regardless of the type of stimulation, situation, or partner.
Limitations of Use:
- ADDYI is not indicated for the treatment of HSDD in postmenopausal women or in men.
- ADDYI is not indicated to enhance sexual performance.