What is the pink pleasure pill (Addyi)?
The "pink pleasure pill" is the common nickname for Addyi (flibanserin), an oral medication approved by the U.S. Food and Drug Administration (FDA) in 2015. It is specifically for premenopausal women diagnosed with acquired, generalized hypoactive sexual desire disorder (HSDD). HSDD is characterized by a persistent lack of sexual fantasies and desire causing distress, not attributable to other conditions, relationship issues, or other medications. Originally intended as an antidepressant, flibanserin was found to impact libido during trials. Addyi is taken once daily at bedtime.
How Addyi works: A different mechanism from Viagra
Addyi is not "female Viagra"; they function differently. While Viagra increases blood flow to treat erectile dysfunction, Addyi acts on the brain. It modulates neurotransmitters like serotonin, dopamine, and norepinephrine to help restore the balance needed for sexual desire. This means it requires daily use, not just before sexual activity, to potentially see modest effects.
Side effects and safety precautions
A major concern with Addyi is severe low blood pressure and fainting, especially when combined with alcohol, leading to an FDA black box warning and strict alcohol avoidance guidelines. Common side effects include dizziness, sleepiness, nausea, fatigue, and dry mouth. Insomnia, constipation, and abdominal pain are less common. Due to risks, only certified healthcare providers can prescribe Addyi. It's not for those with liver problems and shouldn't be taken with certain medications, including some antibiotics and antifungals.
Another option: The as-needed injection Vyleesi
In 2019, the FDA approved Vyleesi (bremelanotide) as a second HSDD treatment for premenopausal women. Vyleesi is a self-administered injection taken into the abdomen or thigh at least 45 minutes before anticipated sex. It works by activating melanocortin receptors in the brain. Like Addyi, Vyleesi's effects can be modest. Side effects include nausea (potentially severe), flushing, and injection site reactions. It can also temporarily raise blood pressure and lower heart rate. There are no alcohol restrictions with Vyleesi.
Comparing Addyi and Vyleesi
| Feature | Addyi (Flibanserin) | Vyleesi (Bremelanotide) |
|---|---|---|
| Mechanism of Action | Modulates brain serotonin and dopamine | Activates melanocortin receptors in the brain |
| Formulation | Oral tablet | Subcutaneous injection |
| Timing of Use | Daily, at bedtime | As-needed, at least 45 mins before sex |
| Key Side Effects | Dizziness, sleepiness, nausea, fainting (esp. with alcohol) | Nausea (can be severe), flushing, headache, injection site reactions |
| Alcohol Restriction | Yes, significant risk of severe hypotension | No, but can cause a brief rise in blood pressure |
Beyond medication: Other treatment approaches for HSDD
HSDD is complex, often stemming from psychological, relational, or physical factors. Treatment frequently involves a combination of approaches beyond medication:
- Psychotherapy: Sex therapy, couples therapy, or CBT can help address underlying issues.
- Lifestyle changes: Improving sleep, managing stress, exercise, and open communication with a partner can enhance sexual health.
- Hormonal therapy: Localized vaginal estrogen may help postmenopausal women with dryness and pain, indirectly improving desire. Testosterone use for HSDD is not FDA-approved and requires caution.
- Managing other medications: Certain drugs, like SSRI antidepressants, can reduce libido. Adjusting dosage or switching medications may be necessary.
Conclusion
The "pink pleasure pill," or Addyi (flibanserin), is a daily oral treatment for premenopausal women with HSDD. It's important to understand it's not a quick fix or an aphrodisiac like male ED drugs. Both Addyi and Vyleesi, a newer as-needed injection, work differently than blood flow enhancers. Women should discuss the root cause of low libido with a healthcare provider to explore all safe and effective options, including medication, therapy, and lifestyle changes, recognizing that a single pill isn't a magical solution.
