From the Guidelines
Yes, Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) can be used to treat hot flashes, particularly in women experiencing menopausal symptoms or cancer patients who cannot use hormone therapy.
Treatment Options
The most commonly prescribed SNRI for this purpose is venlafaxine (Effexor), typically starting at 37.5 mg daily for one week, then increasing to 75 mg daily if needed, as shown in a study published in the Annals of Oncology 1. Other effective options include desvenlafaxine (Pristiq) at 50-100 mg daily, which has been demonstrated to reduce hot flashes by 64% at 12 weeks of treatment 1.
Key Considerations
It is essential to note that while SSRIs, such as paroxetine, can also be effective, they should be used with caution in women taking tamoxifen due to potential interactions with cytochrome P450 2D6 (CYP2D6) 1.
Clinical Guidelines
The American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline recommends offering SNRIs, selective serotonin reuptake inhibitors (SSRIs), gabapentin, lifestyle modifications, and/or environmental modifications to help mitigate vasomotor symptoms of premature menopausal symptoms 1.
Treatment Outcomes
Treatment with SNRIs typically reduces hot flash frequency and severity by 50-60% within 2-4 weeks, improving quality of life for patients experiencing these symptoms 1.
Side Effects and Discontinuation
Side effects may include nausea, dizziness, dry mouth, and sleep disturbances, which often improve after the first few weeks, and patients should taper off these medications gradually rather than stopping abruptly to avoid discontinuation symptoms 1.
From the Research
SNRIs for Hot Flashes
- Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) can be used to treat hot flashes, as they have been shown to reduce the frequency and severity of hot flashes in menopausal and post-menopausal women 2.
- The most effective SNRI for hot flashes is venlafaxine (Effexor), with desvenlafaxine as a second option 2, 3, 4.
- SNRIs work by increasing the levels of serotonin and norepinephrine in the brain, which helps to regulate body temperature and reduce hot flashes 5.
- Common side effects of SNRIs include nausea and constipation, but most resolve within the first week of treatment 2.
- SNRIs may be a safer option for women with a history of breast cancer, as they do not interfere with tamoxifen metabolism like some selective serotonin reuptake inhibitors (SSRIs) do 2.
Treatment Considerations
- Treatment choice should be patient-specific and begin with the lowest dose available 2.
- Women with hypertension should use SNRIs with caution, as they can increase blood pressure in some patients 2.
- Lifestyle modifications, such as exercise and relaxation techniques, may also be helpful in managing hot flashes 6, 5.
- Hormonal replacement therapy is also an option for treating hot flashes, but its safety is disputable 6.