From the Guidelines
Non-hormonal medications such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), gabapentin, and clonidine can effectively manage hot flashes. The most recent and highest quality study 1 recommends offering SNRIs, SSRIs, gabapentin, lifestyle modifications, and/or environmental modifications to help mitigate vasomotor symptoms of premature menopausal symptoms. Some key options include:
- SSRIs like paroxetine (7.5-20mg daily) and fluoxetine (20mg daily)
- SNRIs such as venlafaxine (37.5-150mg daily) and desvenlafaxine (100mg daily)
- Gabapentin, an anticonvulsant, can be taken at 300-900mg daily, often divided into three doses, with evening dosing helpful for nighttime hot flashes
- Clonidine, an antihypertensive, may be prescribed at 0.1-0.2mg daily, though it has more side effects These medications work by affecting neurotransmitters that regulate body temperature or by influencing the central nervous system's thermoregulatory center. Side effects vary by medication class but may include nausea, dizziness, dry mouth, or drowsiness, as noted in studies 1. Patients should start at lower doses and gradually increase as needed, and should discuss with their healthcare provider which option might be best based on their medical history and other medications. It's also important to consider potential interactions, such as the interaction between SSRIs and tamoxifen, which may decrease the conversion of tamoxifen to its active metabolites 1. Overall, the choice of medication should be individualized based on the patient's specific needs and medical history.
From the Research
Non-Hormonal Medications for Hot Flashes
Non-hormonal medications are often used to manage hot flashes in women, especially those with a history of breast cancer or those at high risk of developing breast cancer. The following medications have been studied for their effectiveness in reducing hot flashes:
- Selective serotonin reuptake inhibitors (SSRIs) such as paroxetine, citalopram, and escitalopram 2
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine and desvenlafaxine 3, 2, 4
- Anticonvulsants such as gabapentin and pregabalin 3, 4, 5
- Antihypertensives such as clonidine 5
Considerations for Treatment
When choosing a non-hormonal medication for hot flashes, several factors should be considered:
- The patient's medical history, including any history of breast cancer or risk of developing breast cancer
- The potential interactions between the medication and other medications the patient is taking, such as tamoxifen 2, 4, 5
- The potential side effects of the medication, such as nausea and constipation 2
- The patient's individual needs and preferences
Effective Non-Hormonal Therapies
Several non-hormonal therapies have been shown to be effective in reducing hot flashes, including:
- Paroxetine, which has been shown to reduce the frequency and severity of hot flashes in menopausal women 2, 4
- Venlafaxine, which has been shown to be effective in reducing hot flashes in breast cancer patients and survivors 3, 4, 5
- Gabapentin, which has been shown to be effective in reducing hot flashes in women with a history of breast cancer or those at high risk of developing breast cancer 3, 4, 5