What are the management options for hot flushes in geriatric patients?

From the Guidelines

Management of hot flushes in geriatric patients should prioritize non-pharmacological approaches, including lifestyle modifications and environmental changes, before considering pharmacological options, with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) being potential first-line treatments 1.

Non-Pharmacological Management

Non-pharmacological options should be tried first, including:

• Maintaining a cool environment
• Wearing layered clothing
• Avoiding triggers like spicy foods, alcohol, and caffeine
• Practicing relaxation techniques such as deep breathing or meditation

Pharmacological Management

For pharmacological management, the following options can be considered:

• Selective serotonin reuptake inhibitors (SSRIs) like paroxetine (7.5-25 mg daily) or escitalopram (10-20 mg daily)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (37.5-150 mg daily)
• Gabapentin (300-900 mg daily) or pregabalin (50-150 mg daily) may also help, particularly for night sweats
• Clonidine (0.1-0.2 mg daily) is another option but has side effects like hypotension

Considerations in Geriatric Patients

In geriatric patients, medication should be started at lower doses and titrated slowly to minimize adverse effects, with regular monitoring for drug interactions given the likelihood of polypharmacy. Treatment duration typically ranges from 3-6 months with reassessment of symptoms and consideration of gradual discontinuation 1.

Quality of Life and Morbidity

The goal of treatment is to improve quality of life and reduce morbidity, with consideration of the patient's overall health status and potential for drug interactions 1.

Key Points

• Non-pharmacological approaches should be tried first
• Pharmacological options should be tailored to the individual patient's needs and health status
• Regular monitoring and reassessment are crucial to minimize adverse effects and optimize treatment outcomes.

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. The management options for hot flushes in geriatric patients are not explicitly addressed in the provided drug labels for raloxifene. However, it is mentioned that raloxifene hydrochloride may increase the incidence of hot flashes and is not effective in reducing hot flashes or flushes associated with estrogen deficiency 2. Therefore, raloxifene is not a suitable option for managing hot flushes in geriatric patients.

• No conclusion can be drawn from the provided information regarding other management options for hot flushes in geriatric patients.
• The labels do mention that hot flashes were a common side effect, with an incidence of 14.82 per 100 women-years in the raloxifene group compared to 9.09 per 100 women-years in the placebo group 2.

From the Research

Management Options for Hot Flushes in Geriatric Patients

• Hot flushes are a common symptom in postmenopausal women, affecting over 75% of this population 3.
• Estrogen therapy is the most effective treatment for hot flushes, but it may be contraindicated in some women, making non-hormonal alternatives necessary 4.
• Non-hormonal options for managing hot flushes include:
  • Selective serotonin reuptake inhibitors (SSRIs) such as paroxetine, citalopram, and escitalopram 4, 5.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine and desvenlafaxine 4.
  • Gabapentin, pregabalin, and clonidine 4.
  • Phytoestrogens like genistein 4.
• Non-pharmacological interventions that have shown beneficial results include:
  • Hypnosis 4.
  • Acupuncture 4.
  • Yoga 4.
• Factors that predict hot flushes in postmenopausal women include:
  • Fewer years postmenopause 6.
  • Surgical menopause 6.
  • Previous estrogen or estrogen/progestin therapy 6.
• Low-dose paroxetine has been shown to be effective in reducing hot flushes in postmenopausal women 5.
• The management of hot flushes should be individualized, taking into account the patient's medical history, lifestyle, and preferences 7.