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Addyi is a sexual health medicine, but it is not one Hi-Doctor’s doctors prescribe. When a case touches Addyi, the doctor reviews the questionnaire and offers EU-authorised sexual health alternatives instead — a decision made case by case, never automatically. Although Addyi is associated with sexual health, it is not a medicine that can be prescribed through Hi-Doctor — the alternatives offered carry robust clinical evidence and EMA authorisation.

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Why Hi-Doctor doesn’t prescribe Addyi

Although Addyi is associated with sexual health, it is not a medicine Hi-Doctor’s doctors prescribe. The alternatives offered instead carry robust clinical evidence and EMA authorisation. Addyi (flibanserin) is FDA-approved in the United States for hypoactive sexual desire disorder (HSDD) in premenopausal women, but it has never received marketing authorisation from the European Medicines Agency — the application was withdrawn in 2010 before the Committee for Medicinal Products for Human Use issued a final opinion, on grounds that the modest efficacy did not outweigh the central nervous system safety profile. (EMA withdrawal notice; FDA label NDA 022526)

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How flibanserin works

Flibanserin is a postsynaptic 5-HT1A receptor agonist and 5-HT2A receptor antagonist. Through these actions at serotonin receptors on prefrontal cortex pyramidal neurons, it increases extracellular dopamine and noradrenaline while transiently decreasing serotonin in the prefrontal cortex, nucleus accumbens, and hypothalamus — regions that regulate sexual desire and reward. The proposed mechanism is that this shift in monoamine balance (more dopamine and noradrenaline, less serotonin) counteracts the inhibitory serotonergic tone thought to underlie HSDD. Flibanserin does not alter dopaminergic neurotransmission in the nucleus accumbens in a way associated with misuse potential. (StatPearls flibanserin; PMID 20840530)

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Clinical trial data

The FDA approval was based on three 24-week, randomised, double-blind, placebo-controlled trials in premenopausal women with acquired, generalised HSDD (VIOLET, NCT00360529; DAISY, NCT00360555; and BEGONIA). A pooled analysis of the three trials (2,465 women) showed that flibanserin 100 mg at bedtime increased satisfying sexual events by a mean of 2.1 per 28 days versus 1.2 with placebo (p < 0.0001), improved the Female Sexual Function Index desire domain score (0.9 vs. 0.6, p < 0.0001), and reduced distress measured by the Female Sexual Distress Scale-Revised Item 13 (-0.9 vs. -0.6, p < 0.0001). The coprimary eDiary desire score did not reach statistical significance in VIOLET or DAISY — a pattern the CHMP considered when weighing efficacy against safety. The VIOLET trial (NCT00360529, n=880) compared flibanserin 50 mg, 100 mg and placebo; SSEs increased for both doses versus placebo (p < 0.05 and p < 0.01 respectively), but the eDiary desire coprimary endpoint was not met (p = 0.07). The DAISY trial (NCT00360555, n=1,583) tested 25 mg twice daily, 50 mg twice daily, and 100 mg at bedtime against placebo; only the 100 mg at bedtime regimen significantly increased SSEs (p < 0.01), and again the eDiary desire coprimary did not reach significance for any arm. (PMID 22248038; PMID 22239862; J Womens Health 2019 pooled analysis)
A licensed doctor decides case by case. Hi-Doctor never prescribes without an evaluation — and if none of the alternatives below is safe for a case, the doctor says so at no cost.

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Available treatment options

The doctor reviews a case and chooses between the options below, ruling out cardiovascular and other contraindications first.

Sildenafil (Viagra)

A phosphodiesterase-5 inhibitor. The doctor assesses it after ruling out cardiovascular contraindications.

Tadalafil 10/20mg

A long-acting PDE5 inhibitor, available in low doses for daily use or higher doses on demand. See the Tadalafil page for the full evidence and side-effect profile.

Vardenafil 5/10/20mg

An alternative within the same class, sometimes better tolerated depending on the patient’s profile.

Avanafil 50/100/200mg

A faster-acting PDE5 inhibitor. An option for selected patients based on medical judgement.

Alprostadil (Vitaros)

A topical option for patients who don’t respond to PDE5 inhibitors or have contraindications to them. The doctor assesses suitability.
Medication is paid for separately at the pharmacy of the patient’s choice — Hi-Doctor does not sell or ship medications. See pricing for what the consultation itself covers.

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Your path to treatment

1

Start the online questionnaire

A questionnaire about health and goal, answered online in a few minutes. No in-person appointment and no travel.
2

A doctor reviews the case

A licensed doctor reviews the answers personally within 24 hours. If they need clarification, they message through the private chat in the account.
3

Review and payment

If the doctor does not approve treatment, the consultation fee is refunded in full within 48 hours.
4

Prescription, if appropriate

If a treatment is appropriate, the doctor signs an electronic prescription, valid at any EU pharmacy under EU Directive 2011/24/EU.
5

Ongoing support

Private chat with the doctor for questions, a 4-week check-in, and renewal before the prescription expires.

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Confidentiality

Follow-up happens through the private chat inside the account rather than WhatsApp or SMS, and medication is collected at the nearest pharmacy of the patient’s choice.

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Common questions

Addyi is a medicine associated with sexual health, but Hi-Doctor’s doctors do not prescribe it as a first-line option. The alternatives offered instead carry robust clinical evidence and EMA authorisation.
Although Addyi is associated with sexual health, it is not the first-line medicine Hi-Doctor’s doctors prescribe. The doctor reviews the questionnaire and offers EU-authorised sexual health alternatives — a decision made case by case, never automatically.
A licensed doctor reviews the case and chooses between PDE5 inhibitors such as sildenafil, tadalafil, vardenafil and avanafil, or a topical option called alprostadil. The doctor rules out cardiovascular and other contraindications first.
You fill in an online medical questionnaire in about 4 minutes. An EU-licensed doctor reviews your case in under 24 hours. If appropriate, the doctor issues an electronic prescription valid at any EU pharmacy. You collect the medication at your nearest pharmacy and follow up through the private chat in your account.
If none of the alternatives is safe for your case, the doctor says so at no extra cost and the consultation fee is refunded.

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Start a consultation

Sexual health consultation

Answer the sexual health questionnaire and a registered doctor reviews it. They decide whether treatment is appropriate, which one, and at what dose — and declining is a normal outcome. See what it costs and how the review works.
This page is reference information, not medical advice and not a prescription. Whether a medicine is appropriate for you is decided by a registered doctor after reviewing your consultation.