What is the efficacy of Venlafaxine (Selective Serotonin-Norepinephrine Reuptake Inhibitor) for treating hot flashes?

From the Guidelines

Venlafaxine is a highly effective treatment option for hot flashes, with a significant reduction in frequency and severity of up to 61% compared to placebo, particularly at a dose of 75 mg daily. The efficacy of venlafaxine in treating hot flashes is well-established, with studies showing a median reduction in hot flash score of 37% in those taking 37.5 mg/day and 61% reduction in those taking 75 mg/day and 150 mg/day 1.

Key Points to Consider

• The typical dosage of venlafaxine for hot flashes is 37.5 mg to 75 mg daily, with the optimum dose being 75 mg 1.
• Treatment should begin at the lower dose of 37.5 mg daily for one week before considering an increase to 75 mg if needed.
• Most patients experience improvement within 2-4 weeks of starting treatment.
• Side effects may include nausea, dry mouth, dizziness, and insomnia, which are usually mild and temporary.
• Venlafaxine works by increasing serotonin and norepinephrine levels in the brain, which helps regulate body temperature control mechanisms that become dysregulated during menopause or in cancer patients undergoing treatment.

Clinical Considerations

• Venlafaxine is particularly useful for women with breast cancer who cannot take hormone therapy, as well as for men experiencing hot flashes due to androgen deprivation therapy for prostate cancer.
• When discontinuing venlafaxine, it should be tapered gradually over 1-2 weeks to avoid withdrawal symptoms.
• A recent randomized controlled trial of desvenlafaxine succinate, the major active metabolite of venlafaxine, demonstrated a significant reduction in hot flashes at 12 weeks of 64% with the 100 mg dose compared with 51% with placebo 1.

Recommendation

Based on the most recent and highest quality study, venlafaxine at a dose of 75 mg daily is recommended as a first-line treatment option for hot flashes in women who cannot use hormone therapy 1.

From the Research

Efficacy of Venlafaxine for Hot Flashes

• Venlafaxine, a Selective Serotonin-Norepinephrine Reuptake Inhibitor (SNRI), has been shown to be effective in reducing the frequency and severity of hot flashes in menopausal women 2, 3, 4, 5, 6.
• Studies have demonstrated that venlafaxine can reduce hot flashes by about 25% to 60% 4, 5.
• Venlafaxine is considered a first-line treatment option for hot flashes, particularly for women who cannot take hormonal therapies or have a history of breast cancer 2, 3.

Comparison with Other Treatments

• Venlafaxine has been compared to other antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), and has been found to be effective in reducing hot flashes 2, 3.
• Other nonhormonal agents, such as gabapentin and clonidine, have also been shown to be effective in reducing hot flashes, but venlafaxine is considered a promising option 4, 5.

Safety and Tolerability

• Venlafaxine has been found to be generally well-tolerated, with common side effects including nausea and constipation 2, 3.
• Long-term studies have shown that venlafaxine maintains its efficacy and has good tolerability over time 6.
• However, venlafaxine should be used with caution in women with hypertension, as it can increase blood pressure 2.