> ## Documentation Index > Fetch the complete documentation index at: https://docs.hi-doctor.ai/llms.txt > Use this file to discover all available pages before exploring further. # Flibanserin > Flibanserin (Addyi) has never been authorised in the EU — the alcohol boxed warning, the BEGONIA trial, and the sexual health alternatives a doctor reviews. 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. ## What it is Flibanserin is a nightly tablet that gradually shifts the balance of serotonin, dopamine and noradrenaline signalling in the brain. It is not a hormone and does not change blood flow. ## 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medicines register, checked 27 July 2026, has no entry for flibanserin, Addyi or Girosa as an authorised, refused or withdrawn application.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. ## 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. | Effect | What's known | | ------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | | Severe low blood pressure and fainting from drug/liver interactions | The US label contraindicates flibanserin with moderate or strong CYP3A4 inhibitors and in anyone with liver impairment, because severe hypotension and syncope can occur | | Dizziness | Reported in the US prescribing information | | Sleepiness | Reported in the US prescribing information | | Nausea | Reported in the US prescribing information | | Fainting | Recorded in clinical trials | Source: [US FDA prescribing information — ADDYI (flibanserin) tablets, via DailyMed](https://dailymed.nlm.nih.gov) (boxed warning, contraindications, adverse reactions); [US FDA approved label PDF — ADDYI, 2025 revision](https://www.accessdata.fda.gov). ## What the studies reported 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 (Katz et al., J Sex Med 2013 — BEGONIA trial; [ClinicalTrials.gov · NCT00996164](https://clinicaltrials.gov/study/NCT00996164), [NCT00360529](https://clinicaltrials.gov/study/NCT00360529)). A readout is not the same as peer-reviewed publication. ## 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: Phosphodiesterase-5 inhibitor. The doctor assesses it after ruling out cardiovascular contraindications. Long-acting PDE5 inhibitor, available in low doses for daily use or higher doses on demand. Alternative within the same class, sometimes better tolerated depending on the patient's profile. Faster-acting PDE5 inhibitor, an option for selected patients based on medical judgement. [Vitaros](/library/medicines/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. ## 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](/library/conditions/low-libido) 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. ## How Hi-Doctor handles it The questionnaire covers symptoms, cardiovascular history, current medication and allergies — see how [eligibility works](/essentials/how-it-works) and how [safety checks](/essentials/safety) run. Sexual health is offered as a one-off consultation; the cost is set out on [pricing](/essentials/pricing). The medicine itself, if a doctor prescribes one, is paid separately at a pharmacy. ## Start a 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](/essentials/pricing) and [how the review works](/essentials/how-it-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.