Clinical evidence
Flibanserin (Addyi)
Desire treatment·Sexual-dysfunction treatments
⚠ Critical
Sedation, hypotension and syncope — dangerous with alcohol.
Effect across the cycle
DesireFacilitatory: Modest increase in desire — the target effect.
ArousalFacilitatory: Small improvement in arousal.
PerformanceNeutral: Not an arousal-organ treatment.
ClimaxNeutral: No direct orgasmic effect.
ExperienceFacilitatory: Modest gain in satisfying events.
MemoryNeutral: Not a memory factor.
Mechanism
Daily oral 5-HT1A agonist and 5-HT2A antagonist (weak D4 partial agonist), netting lower serotonin and higher dopamine and norepinephrine in prefrontal cortex to rebalance excitatory and inhibitory sexual cues. FDA-approved (2015) for premenopausal hypoactive sexual desire disorder.
Sex differences & notes
Pooled RCTs (~5,914 women) showed about 0.49 additional satisfying sexual events per month versus placebo, from a baseline near 2.5.
Key sources
- Jaspers et al., JAMA Intern Med 2016