(423) A Case Series of Successful Off-label Use of Flibanserin

Abstract

Abstract Introduction Flibanserin was the first FDA approved drug for hypoactive sexual desire disorder (HSDD) in premenopausal women, but was initially studied as an antidepressant without concern for age or gender. Flibanserin acts as partial agonist at the serotonin receptor 1A and antagonist at serotonin 2A receptor. The mechanism of action is thought to be due to an increase in dopamine and norepinephrine. Post hoc analysis during the pivotal trials showed improvement not just in desire, but in all domains of the Female Sexual Function Index (FSFI) including orgasm, arousal, lubrication and satisfaction. Off label use of flibanserin therefore is of interest to sexual medicine providers. Objective Described here, are four off label uses for flibanserin with successful outcomes in patient’s symptoms and quality of life, including post-orgasmic illness syndrome (POIS), low libido in a eugonadal male, a postmenopausal female with HSDD, and a patient with post-finasteride syndrome (PFS). Methods The first case is of a 40-year-old male patient who presented with a 10 year history of acquired POIS, with significantly debilitating symptoms lasting 1 week after orgasm. After trying a number of different multimodal treatment approaches he finally was on a regimen of Bupropion, Lexapro, Silodosin, Ritalin and Tramadol with a reduction in the duration of his symptoms from 1 week to 4 days, without a change in symptom intensity. Patient was then trialed on 200mg gabapentin nightly and 100mg flibanserin nightly, with progressive discontinuation of prior medications. The second patient, is a 77-year-old hypersexual, postmenopausal woman with a significant trauma history, who presented with gradually worsening HSDD despite adequate lubrication on estring, who was started on 100mg flibanserin nightly. Patient 3 is a 51-year-old male who presented with a 1 year history of low libido and mild erectile dysfunction despite normal testosterone levels and minimal improvements with sildenafil, who was trialed on 100mg flibanserin nightly. The fourth case involves a 26-year-old male presenting with PFS symptoms of erectile dysfunction, decreased libido, genital shrinkage, testicular pain, anxiety and brain fog. Patient had some improvement of erections post discontinuation of finasteride, but was only able to achieve full erection with use of tadalafil. Patient was trialed on 2 months of 100mg flibanserin. Results All four of these patients experienced significant improvement in their presenting symptoms after starting flibanserin nightly. Patient 1, with POIS, had markedly reduced symptom intensity and reduced duration of POIS from 7 days to 1 day. Patient 2 and 3 regained prior libido and quality of life within 2-3 months. Lastly, patient 4 experienced marked improvement in sleep, brain fog, libido and erectile function. Conclusions These cases indicate that flibanserin may be useful to more than premenopausal women and should be studied as a medication with additional pro-sexual affects like bupropion and buspar. Disclosure No