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Physical Treatments for Sexual Problems
Published in Philipa A Brough, Margaret Denman, Introduction to Psychosexual Medicine, 2019
Flibanserin is a centrally-acting agent licenced in the United States 2 years ago for the treatment of female sexual interest/arousal disorder (FSIAD) in pre-menopausal women. More recent studies have also shown some evidence for efficacy in treating hypoactive sexual desire disorder in post-menopausal women (16). However, studies into this and other newer agents such as bremelanotide are sponsored by the pharmaceutical industry, and there has been controversy in the United States about the awarding of the US Food and Drug Administration licence.
Physiology of normal sexual function
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Pierre Clément, Hélène Gelez, François Giuliano
A positive effect of bremelanotide, a nonselective agonist of MC receptors, on sexual desire in premenopausal women with sexual arousal disorder has been reported, and the clinical development of this compound is continued.107
Evaluation of safety for flibanserin
Published in Expert Opinion on Drug Safety, 2020
Anita H Clayton, Louise Brown, Noel N Kim
As a multifunctional serotonin agonist and antagonist, flibanserin is a first-in-class non-hormonal therapy for the treatment of HSDD. Another recently approved medication for treating premenopausal women with HSDD is bremelanotide, a melanocortin receptor agonist that is administered by subcutaneous injection at least 45 minutes before anticipated sexual activity [51]. The most common AEs (placebo-corrected) associated with bremelanotide therapy were nausea (38.7%), flushing (20%), headache (9.4%), injection site reactions (4.8%), and vomiting (4.6%). In bremelanotide-treated patients experiencing nausea, 13% required anti-emetic therapy and 8% discontinued from the trial. Focal hyperpigmentation (face, gingiva and breasts) was reported in 1% of patients in phase 3 placebo-controlled trials. Transient increases in blood pressure and reductions in heart rate also occurred after administration but usually resolved within 12 hours. Bremelanotide is not recommended for patients at high risk for cardiovascular disease and is contraindicated in patients with uncontrolled hypertension or known cardiovascular disease.
Sexual dysfunction with major depressive disorder and antidepressant treatments: impact, assessment, and management
Published in Expert Opinion on Drug Safety, 2022
Joan Winter, Kimberly Curtis, Bo Hu, Anita H. Clayton
Melanocortins and melanocortin agonists (such as bremelanotide) have recently been under more intensive study in the treatment of sexual dysfunction. Of the 5 subtypes of melanocortin receptors, MC3R and MC4R have been shown to be important for sexual function through increased dopamine binding to D1 receptors at the mPOA and enhanced neuronal excitability, causing downstream activation in the nucleus accumbens, VTA, and basolateral amygdala[14]. The amygdala is involved in sensorimotor integration during the desire phase and emotional and affective response following climax[12].
An evaluation of bremelanotide injection for the treatment of hypoactive sexual desire disorder
Published in Expert Opinion on Pharmacotherapy, 2023
Sarah Cipriani, Chiara Alfaroli, Elisa Maseroli, Linda Vignozzi
Clinical evidence shows that, in premenopausal HSDD women, bremelanotide improves sexual desire with a good safety profile and a moderate tolerability (the most common adverse reaction being nausea, up to 40%). The main contraindications are uncontrolled hypertension or known cardiovascular disease, which are not common in young women, and contraception should be advised in case of child-bearing potential. On a positive note, bremelanotide has no key cytochromes or alcohol interactions.