Bremelanotide (PT-141)
Sexual Well-Being
In plain English
Bremelanotide acts on the brain's melanocortin system to increase sexual desire and arousal. An injectable form is FDA-approved to treat low sexual desire in premenopausal women. It is taken before anticipated sexual activity. Nausea, flushing, and headache are common, and it can temporarily raise blood pressure.
The science
Bremelanotide is a synthetic cyclic heptapeptide analog of alpha-MSH that acts as a non-selective melanocortin receptor agonist (notably MC4R) in the central nervous system to modulate sexual desire and arousal, a mechanism distinct from vascular PDE5 inhibitors. The RECONNECT phase 3 randomized trials (Kingsberg 2019) showed subcutaneous bremelanotide 1.75 mg significantly improved sexual desire and reduced desire-related distress in premenopausal women with hypoactive sexual desire disorder, leading to FDA approval (Vyleesi, subcutaneous autoinjector). In men, early randomized data on intranasal PT-141 (Diamond 2004; Safarinejad 2008) showed erectogenic activity, but the intranasal program was discontinued partly over transient blood-pressure increases, and there is no FDA-approved male indication. Common adverse effects are nausea, flushing, and headache; transient rises in blood pressure with compensatory heart-rate decrease occur, and focal hyperpigmentation can develop with repeated use. Compounded nasal sprays, troches, capsules, and non-approved injectables are off-label/not FDA-approved formulations.
References
- Kingsberg et al., Obstet Gynecol 2019 (RECONNECT phase 3 trials)
- Diamond et al., Int J Impot Res 2004 (intranasal PT-141 in men)
- Safarinejad & Hosseini, J Urol 2008 (intranasal bremelanotide, sildenafil non-responders)