From the Guidelines
Gabapentin is the most effective non-hormonal medication for managing hot flashes, reducing their frequency by 49% at a dose of 900 mg daily, as shown in a study published in 2010 1. Several medications can effectively manage hot flashes, including:
- Gabapentin (Neurontin, 300-900 mg daily), which has been shown to be effective in reducing hot flashes by 49% at a dose of 900 mg daily 1
- Venlafaxine (Effexor, 37.5-75 mg daily), an antidepressant that can reduce hot flashes by 50-60% 1
- SSRIs, such as paroxetine (Brisdelle, 7.5 mg daily) and fluoxetine (Prozac, 20 mg daily), which can also reduce hot flashes by 50-60% 1
- Clonidine (0.1-0.2 mg daily), a blood pressure medication that offers modest relief 1
- Pregabalin (Lyrica, 75-150 mg twice daily) and oxybutynin (5-10 mg daily) may also be effective, although the evidence is less strong 1 These medications work by affecting neurotransmitters in the brain's temperature regulation center or by dilating blood vessels. Key points to consider when choosing a medication for hot flashes include:
- The severity of symptoms and patient preferences
- Potential side effects, such as somnolence, fatigue, and dry mouth
- Interactions with other medications, such as tamoxifen
- The need for ongoing treatment, which may be several years. It is essential to discuss your medical history with your healthcare provider to determine the most appropriate option for your specific situation 1.
From the Research
Medications for Vasomotor Symptoms
The following medications can help with vasomotor symptoms, specifically hot flashes:
- Estrogen replacement therapy, which can relieve symptoms by about 80% to 90% 2
- Progestational agents such as megesterol acetate, which can decrease hot flashes by approximately 80% in patients with a history of breast or uterine cancer 2
- Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) such as:
- Gabapentin, which appears promising as therapy for women unable or unwilling to use estrogen 2, 4, 5
- Low-dose estradiol, which can reduce the frequency of symptoms by 52.9% 3
Non-Hormonal Alternatives
Non-hormonal alternatives to hormone therapy for vasomotor symptoms include:
Considerations for Hormone Therapy
Hormone therapy should be considered on a case-by-case basis, taking into account the individual's medical history, risk factors, and personal preferences 5, 6. The decision to use hormone therapy depends on a thorough evaluation of the risks and benefits, and an informed discussion with the patient 5.