From the Guidelines
Gabapentin at a dose of 900 mg/day is the most effective non-hormonal treatment for hot flashes, providing a 49% reduction in symptoms, and is recommended as the first-line treatment for women who cannot take hormones. This recommendation is based on the study by 1, which found that gabapentin was effective in reducing hot flashes in breast cancer patients, with a significant reduction in symptoms compared to placebo. The study also found that gabapentin had a rapid onset of action, with reductions in hot flashes seen as early as 4 weeks.
The mechanism of action of gabapentin is believed to be through central temperature regulatory centers, and it has been shown to be effective in reducing hot flashes in women with breast cancer, as well as those with spontaneous menopausal symptoms 1. Gabapentin is also well-tolerated, with side effects such as dizziness, unsteadiness, and drowsiness affecting up to 20% of women, but these side effects are typically resolved by week 4 of treatment.
Other non-hormonal options, such as venlafaxine, paroxetine, and escitalopram, may also be effective in reducing hot flashes, but the evidence is not as strong as it is for gabapentin 1. Lifestyle modifications, such as avoiding triggers, dressing in layers, and practicing relaxation techniques, may also be helpful in reducing hot flashes, but the evidence for these interventions is limited 1.
In terms of specific dosing, gabapentin at a dose of 900 mg/day is recommended, as this dose has been shown to be effective in reducing hot flashes. Lower doses of gabapentin, such as 300 mg/day, may not be as effective, and higher doses may increase the risk of side effects.
Overall, the evidence suggests that gabapentin is a safe and effective treatment for hot flashes, and is recommended as the first-line treatment for women who cannot take hormones.
From the FDA Drug Label
Raloxifene hydrochloride may increase the incidence of hot flashes and is not effective in reducing hot flashes or flushes associated with estrogen deficiency. Hot flashes 6748 169.91 7170 181.71 0.94 (0.9,0.97) Hot flashes 151 17.31 237 27.06 1.61 (1.31,1.97) Hot flashes 241 9.09 397 14.82 1.68 (1.43,1.97)
Raloxifene is not effective in reducing hot flashes. In fact, it may increase the incidence of hot flashes. The data shows that the incidence of hot flashes is higher in patients taking raloxifene compared to placebo. Therefore, raloxifene is not a suitable medication for treating hot flashes 2, 2.
From the Research
Medication Options for Hot Flashes
- Hormone replacement therapy (HRT) is considered the gold standard for managing vasomotor and vaginal symptoms of menopause, including hot flashes 3.
- Conjugated estrogens (CE) combined with the selective estrogen receptor modulator bazedoxifene (BZA) is a progestin-free HRT option that has been shown to reduce the number and severity of hot flushes in postmenopausal women with a uterus 4.
- Progestogens, such as norethisterone acetate, medroxyprogesterone acetate, and dydrogesterone, can be added to estrogen for endometrial protection, but may increase breast cancer risk and diminish the positive effect of estrogen on colorectal cancer and vascular health 5, 6.
Considerations for HRT
- The choice of HRT regimen, including the type and dose of estrogen and progestogen, should be individualized based on a woman's symptoms, medical history, and preferences 3, 4.
- The addition of progestogen to estrogen therapy can increase the risk of breast cancer, deep vein thrombosis, and other side effects, but may also provide endometrial protection 5, 6.
- Alternative therapies, such as tibolone and raloxifene, may also be effective in reducing hot flashes and other menopausal symptoms, but may have different side effect profiles compared to HRT 7.
Safety and Efficacy of HRT
- The safety and efficacy of HRT regimens, including the risk of breast cancer, cardiovascular disease, and other side effects, should be carefully considered and monitored in individual women 3, 4, 5, 6.
- The choice of HRT regimen should be based on the latest available evidence and guidelines, and should take into account a woman's individual risk factors and medical history 3, 4, 5, 6.