What are alternative and more affordable treatments to Addyi (flibanserin) for hypoactive sexual desire disorder (HSDD)?

Alternative Treatments to Addyi (Flibanserin) for Hypoactive Sexual Desire Disorder

Bupropion is the most affordable and effective alternative to Addyi (flibanserin) for treating hypoactive sexual desire disorder (HSDD), with evidence supporting its off-label use despite limited safety and efficacy data. 1, 2, 3

First-Line Non-Pharmacological Approaches

• Mechanical options such as vibrators or clitoral stimulatory devices can be effective for women with orgasm difficulties and should be considered as part of treatment 1
• Pelvic physical therapy can significantly improve overall sexual function and address orgasm difficulties 1
• Sex therapy, particularly mindfulness-based cognitive behavioral therapy, is a standard treatment approach for HSDD 3
• Addressing psychological factors that contribute to sexual dysfunction through appropriate referrals for anxiety, depression, or other psychological concerns 1

Pharmacological Alternatives to Flibanserin

Recommended Options

• Bupropion (off-label): Considered a primary pharmacologic agent that has shown positive results in treating patients with HSDD 2, 3

  • Advantages: More affordable than Addyi, fewer side effects, and doesn't require avoiding alcohol 1, 2
  • Small studies suggest it may improve sexual function, particularly in breast cancer survivors 4

• Bremelanotide: FDA-approved for premenopausal women with HSDD, used as a self-administered subcutaneous injection as needed 1

  • Acts as a melanocortin receptor agonist
  • May be more convenient for some patients as it's used on an as-needed basis rather than daily

• Buspirone (off-label): Limited data but considered an option by expert panels for premenopausal women with HSDD 1, 3

Special Considerations

• Consider stopping SSRI/SNRIs if the patient is taking them, as these may cause/complicate sexual dysfunction by reducing libido and causing anorgasmia 4
• For postmenopausal women with concurrent dyspareunia (painful intercourse), ospemifene may be beneficial if there's no history of estrogen-dependent cancers 1

Treatment Algorithm

1. First step: Try bupropion (off-label) as the most affordable alternative to flibanserin 1, 2, 3
2. If ineffective: Consider bremelanotide (if cost is not prohibitive) or buspirone 1
3. Concurrent approaches: Implement non-pharmacological strategies including sex therapy, mechanical devices, and addressing psychological factors 1, 3

Important Caveats

• Phosphodiesterase type 5 inhibitors (like sildenafil) are NOT recommended for female sexual dysfunction due to contradictory results in clinical trials 4, 1
• Testosterone therapy is offered by some clinicians for HSDD but its safety and efficacy have not been well established, especially in women with a history of breast cancer 4
• Current pharmacological treatments show limited effectiveness overall - flibanserin results in only about one additional satisfying sexual event every two months compared to placebo 1, 5
• "Restorative or regenerative" therapies lack robust clinical trial data and FDA approval 1

Effectiveness Comparison

• Flibanserin (Addyi) efficacy: Approximately 1 additional satisfying sexual event every 2 months compared to placebo 1, 5
• Bupropion: Shows positive results in treating HSDD but with limited large-scale comparative data 2, 3
• Non-pharmacological approaches: May provide significant benefits without the side effects or costs associated with medications 1, 3