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Pharmacy and Medications

Arimidex and loss of libido

04/26/2006

Question:

HELP> I am white 58 yo female. After double mastectomy surgery, chemo and radiation for estrogen receptor positive breast cancer, I am on Arimidex. ( 20 years ago both ovaries were removed). Terrible loss of libido!!!!! I need my libido back!!!! Oncologist and gynocoligist both had no answers,... please, HELP!! Thank-you!

Answer:

Another name for Arimidex is anastrozole. There is no evidence that anastrozole reduces sex drive or libido. According to the Arimidex package insert, vulvovaginitis (6%), vaginal dryness (2%), and vaginal hemorrhage (2%) have occurred during use. Similar effects related to post-menopausal changes in the vaginal mucosa may also occur. While these effects do not directly affect libido, the prospect of painful sex may deter otherwise normal sexual activity.

Decreased libido is a common complaint of post menopausal women. While the causes for individuals are likely numerous and varied, there is evidence that decreased libido in some women can be related to reduced levels of testosterone. Most naturally post menopausal women have only small decreases in testosterone production compared to pre-menopausal women. However, women whose menopause is related to surgery (removal of the ovaries) have more significantly reduced testosterone. There is reasonably good evidence that testosterone can increase sex drive or libido in such women.

Testosterone is not approved for this indication by the US Food and Drug Administration (FDA). When testosterone is used to increase libido in postmenopausal women, the route of administration of is important. Oral testosterone does not seem to increase sex drive and decreased circulating high density lipoprotein cholesterol levels and significantly increased the incidence of acne and hair growth. Intramuscular injections seem to increase libido, but may cause excessive hair growth and deepening of the voice (masculinization). Transdermal (through the skin) administration also appears to be effective with minimal short term side effects.

A testosterone patch aimed at improving libido in post menopausal women was in development. Women taking using the active patch reported increased libido and more intercourse without increased serum lipids, acne or unwanted hair growth. However the was product was withdrawn when the FDA refused to approve it unless the company provided data showing long term safety. Obtaining this data would require expensive long term studies. Most likely the company could not justify the additional expense necessary to complete these studies. FDA committee members were concerned about the chronic use of the drug and unknown risks of breast cancer and cardiovascular problems. The committee had additional concerns regarding chronic use of testosterone with estrogen in this population, and the potential for off-label use.

Currently there is no commercially available transdermal testosterone product on the market. Using testosterone injection a pharmacist that specializes in compounding who receives a doctor's prescription can prepare a gel for the skin or a lozenge for delivery of the drug through the oral mucosa. However, the safety and efficacy of these extemporaneous products is not known.

Some researchers are trying some of the same approaches that are used in men...Viagra, alprostadil cream, oral phentolamine, but there is no current evidence that supports increased libido in women with these drugs.

"OTC" Wonder Drugs advertised on the internet/email/television/etc. stating that they are useful for improving female libido are likely to be ineffective. These products are sold as dietary supplements under Dietary Supplement Health and Education Act of 1994(DSHEA). Remember that dietary supplements do not need to prove that they are safe or effective prior to being marketed. These products are unlikely to work, may not be safe and are expensive. A number of these products are available. Some common ingredients include licorice, red raspberry, red clover, kudzu and black cohosh. Red clover, kudzu, and black cohosh have estrogenic effects and should not be used by women with hormone sensitive conditions such as endometriosis and breast, uterine, and ovarian cancer.

This answer was prepared by Dan Stalker, a PharmD candidate at the University Of Cincinnati College Of Pharmacy.

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Response by:

Robert James Goetz, PharmD, DABAT
Assistant Professor of Pharmacy Practice
College of Medicine
University of Cincinnati