What is the role of duloxetine in managing hot flushes?

From the Guidelines

Duloxetine is a recommended option for managing hot flushes, particularly in women who cannot take hormone replacement therapy, as it has been shown to decrease the intensity and severity of vasomotor symptoms. According to the American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline 1, SNRIs, including duloxetine, are recommended as a nonhormonal medication to help mitigate vasomotor symptoms of premature menopausal symptoms. The guideline suggests that primary care clinicians should offer SNRIs, selective serotonin reuptake inhibitors (SSRIs), gabapentin, lifestyle modifications, and/or environmental modifications to help manage hot flushes.

Some key points to consider when using duloxetine for hot flushes include:

• The typical dosage ranges from 30-60 mg daily, with treatment usually starting at 30 mg and potentially increasing after 1-2 weeks if needed
• Duloxetine works by increasing serotonin and norepinephrine levels in the brain, which helps regulate body temperature and reduce the frequency and severity of hot flushes
• This medication is particularly useful for women with concurrent depression or anxiety, as it addresses both mood disorders and vasomotor symptoms
• Patients should be aware that side effects may include nausea, dry mouth, constipation, fatigue, and decreased appetite, particularly during the first few weeks of treatment
• Duloxetine should be tapered gradually when discontinuing to avoid withdrawal symptoms
• It typically takes 2-4 weeks to notice significant improvement in hot flush symptoms, and treatment may continue for several months or longer depending on symptom persistence and individual response.

From the Research

Role of Duloxetine in Managing Hot Flushes

• Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that has been studied for its potential in managing hot flushes, particularly in breast cancer survivors and menopausal women 2, 3.
• A study published in 2018 found that duloxetine was effective in reducing the frequency and severity of hot flushes in breast cancer survivors, with similar efficacy to escitalopram, a selective serotonin reuptake inhibitor (SSRI) 2.
• However, another study published in 2009 suggested that duloxetine should be reserved as a last-line therapy for hot flushes due to limited data on its efficacy and safety compared to other antidepressants 4.
• A systematic review of clinical trials published in 2022 found that while some SNRIs, such as venlafaxine and desvenlafaxine, have shown significant efficacy in treating menopausal hot flushes, studies on duloxetine are limited, and further research is needed to confirm its effectiveness 3.
• A case report published in 2007 described a patient who experienced facial flushing, possibly caused by inappropriate administration of duloxetine, highlighting the importance of proper dosing and administration of the medication 5.

Efficacy and Safety of Duloxetine

• The available evidence suggests that duloxetine may be effective in reducing hot flushes in some populations, but its efficacy and safety profile is not as well-established as some other antidepressants, such as SSRIs and other SNRIs 4, 3.
• Duloxetine has been shown to have a significant reduction in hot flush frequency and severity in breast cancer survivors, but more studies are needed to confirm its effectiveness in other populations 2.
• The medication should be used with caution and under the guidance of a healthcare professional, as it can cause side effects, such as facial flushing, and may interact with other medications 5, 4.