Flibanserin (Addyi): clear facts for women with low sexual desire

Flibanserin—sold as Addyi—is a daily pill approved for premenopausal women with hypoactive sexual desire disorder (HSDD). It’s the only oral drug specifically approved for this condition, but its effects are modest and the safety rules are strict. If you’re wondering whether it’s worth trying, here’s a straight, useful guide.

How flibanserin works and who it helps

Flibanserin affects brain chemicals involved in desire, mainly serotonin and dopamine. Trials showed a small but measurable increase in sexual desire and in the number of satisfying sexual events each month. That means some women notice a real benefit, while others get little or nothing. It’s approved only for premenopausal women with HSDD—not for men and not for women whose low desire is caused by relationship problems, psychiatric conditions, or other medical issues.

How to take it and what to expect

The usual dose is one 100 mg tablet taken at bedtime. Taking it at night helps reduce dizziness and sleepiness—two of the most common side effects. Don’t expect fast results; doctors often allow several weeks to see if it helps. If you don’t notice improvement after a few months, your provider may stop it.

Common side effects include dizziness, sleepiness, nausea, fatigue, and dry mouth. More serious risks are low blood pressure and fainting, especially if flibanserin is mixed with alcohol or with certain medications that affect the same liver enzymes.

Avoid alcohol while taking flibanserin. Also tell your doctor about any other medicines you take—especially strong CYP3A4 inhibitors like ketoconazole, clarithromycin, some HIV drugs, or herbal products that affect liver enzymes. Flibanserin is not recommended if you have liver problems.

Because of safety issues, a frank talk with your clinician matters. Mention all medicines, supplements, and how much you drink. Pregnant or breastfeeding women should not use it.

If cost is a concern, check whether your insurer covers it; coverage varies. Some manufacturers offer patient-assistance or coupons that may lower out-of-pocket costs.

Looking for alternatives? Bremelanotide (Vyleesi) is an FDA-approved injectable option for premenopausal HSDD that works differently and is used as needed before sexual activity. Non-drug approaches—sex therapy, counseling, hormone checks, or addressing relationship and stress issues—are often helpful and have no drug risks. Some clinicians sometimes consider off-label options like testosterone, but that requires careful monitoring and isn’t universally recommended.

Want to try flibanserin? Start with a conversation. A clinician can confirm HSDD isn’t from another cause, review safety, and help you weigh benefits against risks. If you start it, follow safety advice closely—especially about alcohol and interacting drugs.