From the Guidelines
Propranolol is not recommended as a first-line treatment for vasomotor symptoms, and its use is not mentioned in the current guidelines. The most recent and highest quality study, published in the Journal of Clinical Oncology in 2018 1, recommends hormone therapy as the most effective intervention for women with vasomotor symptoms. For women unwilling or unable to use hormonal therapy, alternatives such as paroxetine, venlafaxine, gabapentin, or clonidine are suggested.
Key Points to Consider
- Hormone therapy is the most effective treatment for vasomotor symptoms, but it may be contraindicated in certain cases, such as hormone-sensitive breast cancer 1.
- Alternative treatments, including paroxetine, venlafaxine, gabapentin, or clonidine, may be used for women who cannot take hormone therapy 1.
- Psychosocial counseling and clinical hypnosis may also provide benefits in reducing vasomotor symptoms 1.
Important Considerations
- The use of systemic hormone therapy is not necessarily contraindicated in patients with other hormone-sensitive cancers, and clinicians should discuss all options with their patients 1.
- Adverse events associated with alternative treatments, such as clonidine, include hypotension, light-headedness, headache, dry mouth, dizziness, sedation, and constipation 1.
Clinical Decision Making
- When considering treatment options for vasomotor symptoms, clinicians should prioritize hormone therapy, if not contraindicated, due to its high efficacy 1.
- Alternative treatments should be considered on a case-by-case basis, taking into account the patient's individual needs and medical history 1.
From the FDA Drug Label
The mechanism of the antihypertensive effect of propranolol has not been established Among the factors that may be involved in contributing to the antihypertensive action include: (1) decreased cardiac output, (2) inhibition of renin release by the kidneys, and (3) diminution of tonic sympathetic nerve outflow from vasomotor centers in the brain Although total peripheral resistance may increase initially, it readjusts to or below the pretreatment level with chronic use of propranolol.
The FDA drug label does not answer the question.
From the Research
Propranolol for Vasomotor Symptoms
- Propranolol has been studied as a potential treatment for vasomotor symptoms, with one study finding it to be effective in reducing the frequency and severity of these symptoms 2.
- The study, conducted in 1981, was a double-blind, placebo-controlled, crossover trial involving 37 menopausal women, and found that propranolol had a statistically significant effect on the reduction of both the frequency and severity of vasomotor symptoms (P less than 0.01) 2.
- However, other studies have not specifically mentioned propranolol as a treatment option for vasomotor symptoms, instead focusing on other nonhormonal therapies such as selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, gabapentin, and fezolinetant 3, 4, 5.
- Propranolol is a noncardioselective β-blocker with a range of uses, including the control of hypertension, pheochromocytoma, myocardial infarction, and cardiac arrhythmias, but its use in treating vasomotor symptoms is not widely established 6.
Nonhormonal Treatment Options
- Nonhormonal therapies, such as selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, gabapentin, and fezolinetant, may be alternative treatment options for vasomotor symptoms in women who cannot or choose not to take hormones 3, 4, 5.
- These therapies have been shown to be effective in reducing the frequency and severity of vasomotor symptoms, although the evidence is not as strong as it is for hormone therapy 3, 4, 5.
- Lifestyle changes, such as regulation of core body temperature, relaxation techniques, regular physical activity, weight loss, and smoking cessation, may also help reduce the risk of vasomotor symptoms and should be implemented by all women with menopause-associated vasomotor symptoms 4.