Barakeh Donna, Mdaihly Hadil, Karaoui Lamis R
Houston Methodist Hospital, Houston, TX, USA.
School of Pharmacy, Lebanese American University, Byblos, Lebanon.
Ann Pharmacother. 2025 Feb;59(2):148-161. doi: 10.1177/10600280241253273. Epub 2024 May 20.
This review aims to provide an overview of pharmacologic management for hypoactive sexual desire disorder (HSDD) in premenopausal women, with a focus on available agents.
Through a literature search on PubMed, Google Scholar, and ClinicalTrials.gov from 1999 to 2024, studies were selected using the following MeSH search terms: hypoactive sexual desire disorder, premenopause, pharmacologic management, flibanserin, bremelanotide, buspirone, bupropion, and testosterone, excluding those involving postmenopausal women or other sexual disorders. Product monographs were also reviewed.
Relevant English-language studies or those conducted in humans were considered.
Hypoactive sexual desire disorder, characterized by a lack of motivation for sexual activity, predominantly affects women aged 45 years and older. Treatment involves a multimodal approach, including nonpharmacologic interventions such as psychotherapy and lifestyle adjustments, alongside pharmacologic options. Although bupropion and buspirone may be considered off-label treatments, flibanserin and bremelanotide are the sole medications approved by the Food and Drug Administration for generalized acquired HSDD in premenopausal women. However, caution is advised due to their limited efficacy, potential adverse effects, and transparency issues in reporting.
Hypoactive sexual desire disorder, while not life-threatening, significantly impacts well-being and relationships. Pharmacotherapy, including options like flibanserin and bremelanotide, is essential within a multidisciplinary approach. Validated tools and objective measures inform tailored premenopausal HSDD care plans and aid in striking a balance between potential risks and adverse effects while maximizing meaningful clinical benefits, including for transgender individuals.
Clinicians must discern important distinctions between flibanserin, bremelanotide, and other agents when managing premenopausal HSDD. Further research with the most suitable clinical endpoints and consideration of patient factors are crucial before widespread adoption of flibanserin and bremelanotide. Pharmacists are encouraged to embrace this opportunity to provide premenopausal HSDD care in ambulatory and community practice settings.
本综述旨在概述绝经前女性性欲减退障碍（HSDD）的药物治疗，重点关注可用药物。
通过对1999年至2024年PubMed、谷歌学术和ClinicalTrials.gov的文献检索，使用以下医学主题词（MeSH）检索词选择研究：性欲减退障碍、绝经前、药物治疗、氟班色林、布雷美拉诺肽、丁螺环酮、安非他酮和睾酮，排除涉及绝经后女性或其他性功能障碍的研究。还查阅了药品说明书。
考虑相关的英文研究或在人体中进行的研究。
性欲减退障碍的特征是缺乏性活动动机，主要影响45岁及以上的女性。治疗采用多模式方法，包括心理治疗和生活方式调整等非药物干预措施以及药物选择。虽然安非他酮和丁螺环酮可能被视为非适应证治疗，但氟班色林和布雷美拉诺肽是美国食品药品监督管理局批准用于绝经前女性广泛性获得性HSDD的唯一药物。然而，由于其疗效有限、潜在不良反应以及报告中的透明度问题，建议谨慎使用。
性欲减退障碍虽然不危及生命，但会显著影响幸福感和人际关系。在多学科方法中，包括氟班色林和布雷美拉诺肽等药物治疗至关重要。经过验证的工具和客观测量方法为量身定制的绝经前HSDD护理计划提供依据，并有助于在潜在风险和不良反应之间取得平衡，同时最大限度地提高有意义的临床益处，包括对 transgender 个体。
临床医生在管理绝经前HSDD时必须区分氟班色林、布雷美拉诺肽和其他药物之间的重要差异。在广泛采用氟班色林和布雷美拉诺肽之前，以最合适的临床终点进行进一步研究并考虑患者因素至关重要。鼓励药剂师抓住这个机会，在门诊和社区实践环境中提供绝经前HSDD护理。
