Are any of these medications associated with hot flashes?

Medications Associated with Hot Flashes

From your medication list, duloxetine (CYMBALTA) and progesterone (PROMETRIUM) are associated with hot flashes as documented side effects. 1, 2

Duloxetine (CYMBALTA)

• Hot flashes (described as "flushing" in clinical trials) occur in approximately 3% of patients taking duloxetine compared to 1% in placebo groups 1
• As an SNRI (serotonin-norepinephrine reuptake inhibitor), duloxetine paradoxically can both cause hot flashes as a side effect and be used to treat hot flashes in some patients 3
• The mechanism behind SNRI-induced hot flashes involves alterations in serotonin and norepinephrine neurotransmission, which can affect thermoregulatory centers 3

Progesterone (PROMETRIUM)

• Clinical trials show that 7% of women taking progesterone experience night sweats compared to 17% in placebo groups 2
• Hot flashes were reported in 11% of women taking progesterone with conjugated estrogens compared to 35% in placebo groups 2
• Paradoxically, progesterone is sometimes used to treat hot flashes, with studies showing it may have an independent effect on relieving hot flashes 4

Other Medications to Consider

• While not on your list, it's worth noting that tamoxifen (a breast cancer medication) is strongly associated with hot flashes, occurring in approximately 81% of women taking it 3
• Raloxifene (another SERM) is also associated with increased hot flash severity and frequency compared to placebo 3

Treatment Options for Medication-Induced Hot Flashes

If hot flashes are problematic:

• Non-hormonal pharmacologic options include:

  • Gabapentin (900 mg/day) can reduce hot flash severity by 46% compared to 15% with placebo 3
  • Venlafaxine (37.5-75 mg/day) can significantly reduce hot flash frequency and severity 3
  • Clonidine (0.1 mg/day) may be useful for mild to moderate hot flashes 3
  • Fezolinetant is a newer option that avoids the 10-20% treatment withdrawal rate seen with SSRIs/SNRIs 5

• Non-pharmacologic approaches include:

  • Acupuncture, exercise/physical activity, yoga, and cognitive behavioral therapy may help manage hot flashes 3
  • Weight loss if overweight or obese can reduce hot flash symptoms 3

Clinical Considerations

• When selecting treatment for hot flashes, consider:

  • Side effect profiles: SNRIs/SSRIs have 10-20% discontinuation rates due to side effects versus 10% for gabapentin 3
  • Onset of action: Most pharmacologic treatments work rapidly (within 1 week) 3
  • Drug interactions: Some SSRIs (particularly paroxetine) should be used with caution in women taking tamoxifen due to CYP2D6 inhibition 3
  • Comorbidities: SNRIs/SSRIs may be preferred if concurrent depression is present; gabapentin may be preferred if neuropathic pain is present 3

• Hot flashes from medications often improve with time as the body adjusts to the medication, but may persist throughout treatment 6

Remember to discuss any concerning symptoms with your healthcare provider before making changes to your medication regimen.