Addyi vs Vyleesi: Pill or Injection for Low Libido, and How Well Each Works
Addyi is a nightly pill for women under 65; Vyleesi is an as-needed injection for premenopausal women only. No trial has compared them head to head, each showed small average gains over placebo, and each has a trade-off: alcohol timing and sleepiness for Addyi, nausea for Vyleesi.
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This guide
Women's Libido & Hormones- Question
- What is the difference between Addyi and Vyleesi, and which works better?
- Sources
- 5 cited
- Quick answers
- 3 questions
- Clinician review
- None; sources cited inline
Key takeaways
5 points- Addyi (flibanserin) is a 100 mg pill taken every night at bedtime by women under 651; Vyleesi (bremelanotide) is a 1.75 mg injection used as needed at least 45 minutes before sex, for premenopausal women only2.
- No trial has compared them directly. Addyi added 0.6 to 1.0 more satisfying sexual events per 28 days than placebo, on average, in premenopausal women1; Vyleesi improved desire and distress scores but not the number of satisfying sexual events2.
- Addyi's boxed warning covers fainting and severe low blood pressure with alcohol: wait at least 2 hours after one or two drinks, or skip the dose after three or more1.
- Nausea is Vyleesi's main drawback: 40% of users had it, and 18% stopped the trials because of side effects vs 2% on placebo2.
- Both labels say to stop after 8 weeks if there is no improvement12.
At a glance
Both drugs treat acquired, generalized hypoactive sexual desire disorder (HSDD): low sexual desire that causes marked distress or interpersonal difficulty and is not due to another medical or psychiatric condition, relationship problems or a medicine12. Neither is approved for men or to enhance sexual performance12.
- Form: Addyi is a pill taken once daily at bedtime1; Vyleesi is a self-injection under the skin of the abdomen or thigh before sex2.
- Who it is for: Addyi covers women under 65, before or after menopause1; Vyleesi is for premenopausal women only2.
- Limits: Vyleesi no more than one dose in 24 hours and no more than 8 doses a month2.
- Main trade-off: alcohol rules, dizziness and sleepiness for Addyi1; nausea, flushing and a brief rise in blood pressure for Vyleesi2.
How well Addyi works
In three 24-week trials in premenopausal women, Addyi added 0.6 to 1.0 more satisfying sexual events per 28 days than placebo on average (median differences 0.5 to 1.0). In a trial of postmenopausal women under 65 (mean age 55), the gain was 0.4 events per 28 days, and the label's indication was updated in December 2025 to cover women under 651.
In the label's responder analysis, 29% to 39% of premenopausal women on Addyi rated their satisfying events much or very much improved, vs 21% to 31% on placebo, a difference of 8 to 9 percentage points1.
A meta-analysis by Dutch and Belgian academic researchers, covering 5 published and 3 unpublished trials (5,914 women) found about half an extra satisfying sexual event a month, graded the evidence very low quality, and found women's own ratings indicated minimal improvement to no change3.
How well Vyleesi works
In the two RECONNECT trials, 1,267 premenopausal women (mean age 39) were randomized to Vyleesi or placebo, used as needed for 24 weeks. In the pooled data, desire scores rose by 0.35 points and distress about low desire fell by 0.33 points more than on placebo. The trials were funded by Palatin Technologies and AMAG Pharmaceuticals, and the author list includes people affiliated with both companies4.
The number of satisfying sexual events, a secondary endpoint, did not differ significantly from placebo. More women stopped Vyleesi early than placebo: 40% vs 13% in one trial and 39% vs 25% in the other2.
A re-analysis by two US psychologists questioned whether the desire and distress scales used are validated for HSDD, and found effects ranging from nil to small on 8 outcomes that had not been published5.
Side effects and safety warnings
Addyi: in premenopausal trials, dizziness (11.4% vs 2.2% on placebo), sleepiness (11.2% vs 2.9%) and nausea (10.4% vs 3.9%) were the most common side effects. It is taken at bedtime because daytime doses raise the risk of low blood pressure, fainting, injury and sedation, and users should avoid driving until at least 6 hours after a dose1.
Addyi's boxed warning: alcohol close in time to the dose raises the risk of severe low blood pressure and fainting. Moderate or strong CYP3A4 inhibitor drugs and liver impairment are contraindications, and birth control pills, as weak CYP3A4 inhibitors, raise Addyi levels and side effects1.
Vyleesi: nausea affected 40% of users and 13% needed anti-nausea medicine, though it improved for most with the second dose. Flushing (20%) and headache (11%) were also common. Each dose raises blood pressure by up to 6 mmHg systolic and lowers heart rate slightly, usually back to baseline within 12 hours, and Vyleesi is contraindicated with uncontrolled high blood pressure or known heart disease2.
Dark patches of skin on the face, gums or breasts (focal hyperpigmentation) occurred in 1% of trial users at up to 8 doses a month, did not always fade after stopping, and are more likely with darker skin and daily dosing. Vyleesi can sharply lower levels of oral naltrexone, so avoid it with naltrexone products for alcohol or opioid addiction2.
Which one, and when to see a clinician
Menopause status and age decide much of it: after menopause, only Addyi is approved, and only under 6512. Someone who drinks most evenings may find Addyi's alcohol rules hard to live with1; someone with uncontrolled blood pressure or heart disease cannot use Vyleesi2.
Rule out other causes first. Our low libido guide covers causes and other options, and testosterone for women covers the off-label option after menopause. For bremelanotide access and cost, see PT-141 online.
- Pregnancy: there are no studies of Addyi in pregnant women, and it is not recommended while breastfeeding1; stop Vyleesi if pregnancy is suspected, and use effective contraception while taking it2.
- If you feel faint on Addyi, lie down right away and seek medical help if the symptoms do not go away1.
- Tell your prescriber about every medicine you take, including birth control pills before starting Addyi1 and any naltrexone before starting Vyleesi2.
- Stop and reassess after 8 weeks if there is no improvement; both labels say so12.
Quick answers
Questions
3 answersIs Addyi or Vyleesi more effective?
No head-to-head trial exists, and their trials used different main measures, so the numbers cannot be compared directly. Each showed small average gains over placebo123.
Can I drink alcohol on Addyi?
The label says to wait at least 2 hours after one or two standard drinks before the bedtime dose, to skip the dose after three or more, and to avoid alcohol until the next day after taking it1.
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References
Every study and document cited in this guide, numbered as in the text.
Sources
5 sources- 1ADDYI (flibanserin) tablets: prescribing information (revised 12/2025). U.S. Food and Drug Administration, 2025.
- 2VYLEESI (bremelanotide injection): prescribing information (revised 10/2020). U.S. Food and Drug Administration, 2020.
- 3Efficacy and Safety of Flibanserin for the Treatment of Hypoactive Sexual Desire Disorder in Women: A Systematic Review and Meta-analysis. JAMA Intern Med, 2016. PMID 26927498
- 4Bremelanotide for the Treatment of Hypoactive Sexual Desire Disorder: Two Randomized Phase 3 Trials. Obstet Gynecol, 2019. PMID 31599840
- 5Small Effects, Questionable Outcomes: Bremelanotide for Hypoactive Sexual Desire Disorder. J Sex Res, 2024. PMID 36809187
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