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    Taking Sides: Should ob/gyns prescribe flibanserin for their patients?

     

    To prescribe flibanserin, a physician must answer 4 simple questions online. The site with training and materials is: https://www.addyirems.com/AddyiUI/rems/home.action. As in the case of any drug, flibanserin must be used wisely.6 Its use with multiple weak CYP3A4 inhibitors (for example, oral contraceptives, cimetidine, fluoxetine, ginkgo, and ranitidine) may increase flibanserin exposure. Its use with strong CYP2C19 inhibitors (including proton pump inhibitors, selective serotonin reuptake inhibitors, benzodiazepines, antifungals) may increase flibanserin levels.

    On the other hand, using flibanserin with CYP3A4 inducers (carbamazepine, phenobarbital, phenytoin, rifabutin and rifampin) will decrease flibanserin levels. Digoxin levels may be increased if used concomitantly. Watch closely for excessive sedation when flibanserin is used with CNS depressants such as diphenhydramine, opioids, hypnotics, and benzodiazepines. Simvastatin levels may be increased by a factor of 1.5.

    During a woman’s annual visit, clinicians may want to use a simple office screener, the Decreased Sexual Desire Screener,7 in practice or simply inquire about sexual function and sexual concerns. Not all women with sexual dysfunction are candidates for flibanserin; however many are and with shared decision-making, it is an excellent option for otherwise healthy women with HSDD. The bottom line is that flibanserin 100 mg daily taken orally at bedtime is an effective therapeutic option for women with HSDD.

     

    Dr Thacker has no conflicts of interest to report in respect to the content of this article.

     

    References

    1. Gao Z, Yang D, Yu L, Cui Y. The efficacy and safety of flibanserin in women with HSDD: A systemic review and meta-anaylsis. J Sex Med. 2015;12:2095–2104.

    2. Simon JA, Kingsberg SA, Shumel B, et al. Efficacy and safety of flibanserin in postmenopausal women with HSDD: results of the SNOWDROP trial. Menopause. 2014;21(6):633–640.

    3. Jaspers L, Feys F, Bramer W, et al. Efficacy and safety of Flibanserin for the treatment of HSDD in women. A systemic review and meta-analysis. JAMA Intern Med. 2016;176(4):453–462.

    4. Woloshin S, Schwartz LM. US FDA Approval of Flibanserin: Even the Score does not add up. JAMA Intern Med. 2016;176(4):439–442.

    5. Joff JV, Chang C, Sewell C, et al. FDA Approval of Flibanserin-Treating HSDD. NEJM. 2016:374;2:101–104.

    6. Flibanserin (Addyi) for HSDD. Med Lett Drugs Ther. Sept 28, 2015:1478;133–135.

    7. Clayton AH, Goldfischer ER, Goldstein I, et al. Validation of the decreased sexual desire screener (DSDS): a brief diagnostic instrument for generalized acquired female HSDD. J Sex Med. 2009;6:730–738.

     

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