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Flibanserin, sold in the United States as Addyi, is a tablet taken every night at bedtime for premenopausal women whose low sexual desire causes real distress. It is not a hormone and not the female version of an erection tablet: it slowly adjusts brain chemical signalling and can take weeks before any effect shows.
We don’t prescribe flibanserin today, but our doctors can review your case and propose an equivalent sexual health treatment with EU authorisation.

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What it is

Flibanserin is a nightly tablet that gradually shifts the balance of serotonin, dopamine and noradrenaline signalling in the brain. At clinically relevant doses it acts predominantly as a 5-HT1A receptor agonist and secondarily as a 5-HT2A receptor antagonist, with additional weaker antagonist activity at 5-HT2C and dopamine D4 receptors. Its postsynaptic action on prefrontal cortex pyramidal neurons increases dopamine and noradrenaline release while reducing serotonin release in the prefrontal cortex — a region involved in sexual interest and desire. (Stahl et al., J Sex Med 2011, PMID 20840530) It is not a hormone and does not change blood flow.

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Why it isn’t authorised in the EU

Flibanserin has never been authorised anywhere in the European Union. The EMA public medicines register, checked 27 July 2026, has no entry for flibanserin, Addyi or Girosa as an authorised, refused or withdrawn application. Because of that, no EU doctor can prescribe it and Hi-Doctor does not offer it.

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What has been reported

Alcohol interaction (boxed warning). The US label carries a boxed warning that taking flibanserin and alcohol close together in time increases the risk of severe low blood pressure and fainting. At first US approval in 2015, alcohol was an outright contraindication; the warning was revised in 2019 to tell patients to wait at least two hours after one or two standard drinks before taking the tablet.
Source: US FDA prescribing information — ADDYI (flibanserin) tablets, via DailyMed (boxed warning, contraindications, adverse reactions); US FDA approved label PDF — ADDYI, 2025 revision. The mechanism of the alcohol interaction is not fully characterised, but both flibanserin and ethanol are metabolised by CYP3A4 and CYP2C19; the presence of ethanol is thought to reduce first-pass metabolism of flibanserin, raising peak plasma concentrations enough to cause severe hypotension and syncope. The same mechanism underlies the contraindication with moderate or strong CYP3A4 inhibitors (for example, ketoconazole, clarithromycin, grapefruit juice), which also raise flibanserin exposure substantially.

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What the studies reported

The BEGONIA trial (Katz et al., J Sex Med 2013, NCT00996164) was a randomised, double-blind, placebo-controlled phase III study that ran for 24 weeks across North America. Premenopausal women with hypoactive sexual desire disorder (HSDD) received flibanserin 100 mg at bedtime or placebo. The coprimary endpoints were the number of satisfying sexual events (SSE) per month, desire score on the Female Sexual Function Index, and distress score. The difference from placebo amounted to roughly one extra SSE per month, and the placebo group also improved substantially. The trial did not include an active comparator arm and did not assess long-term outcomes beyond 24 weeks.

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What can be considered instead

Flibanserin is specific to low sexual desire; the alternatives a doctor reviews for sexual health more broadly depend on the concern:

Sildenafil (Viagra)

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

Tadalafil 10/20mg

Long-acting PDE5 inhibitor, available in low doses for daily use or higher doses on demand.

Vardenafil 5/10/20mg

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

Avanafil 50/100/200mg

Faster-acting PDE5 inhibitor, an option for selected patients based on medical judgement.
Vitaros (alprostadil cream) is a topical option considered for patients who don’t respond to PDE5 inhibitors or have contraindications to them. A licensed doctor decides case by case — we never prescribe without evaluation.

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Common questions

Flibanserin is a nightly tablet that gradually shifts the balance of serotonin, dopamine and noradrenaline signalling in the brain. It is prescribed for premenopausal women whose low sexual desire causes real distress — a condition called hypoactive sexual desire disorder (HSDD). It is not a hormone and does not change blood flow.
Flibanserin has never been authorised anywhere in the European Union. The EMA public medicines register, checked 27 July 2026, has no entry for flibanserin, Addyi or Girosa. Because of that, no EU doctor can prescribe it and Hi-Doctor does not offer it.
Within Hi-Doctor’s sexual health consultation, doctors review the case and consider EU-authorised options that fit it. A GP or gynaecologist can also look at hormones, mood, medication side effects and relationship factors together. See low sexual desire for more detail.
The BEGONIA trial ran for 24 weeks in North America. The difference from placebo amounted to roughly one extra satisfying sexual event per month, and the placebo group also improved substantially.
The US label carries a boxed warning that taking flibanserin and alcohol close together in time increases the risk of severe low blood pressure and fainting. At first approval in 2015, alcohol was an outright contraindication; the warning was revised in 2019 to tell patients to wait at least two hours after one or two standard drinks before taking the tablet.

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How Hi-Doctor handles it

The questionnaire covers symptoms, cardiovascular history, current medication and allergies — see how eligibility works and how safety checks run. Sexual health is offered as a one-off consultation; the cost is set out on pricing. The medicine itself, if a doctor prescribes one, is paid separately at a pharmacy.

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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.