From the Guidelines
Paroxetine is the most effective SSRI for treating hot flashes, with a reduction in hot flash frequency and severity of about 62-65%. This is based on the study by 1, which found that controlled release paroxetine reduced the hot flash composite score in menopausal women by 62% with 12.5 mg daily.
Key Points
- The typical dosage of paroxetine for hot flashes is 7.5-20mg taken once daily, with the brand name Brisdelle being specifically FDA-approved for menopausal hot flashes.
- Other SSRIs like sertraline (50-100 mg) have shown mixed results for hot flashes, with some studies suggesting a reduction in hot flash frequency and severity, but others finding no significant benefit 1.
- The mechanism of action of paroxetine in reducing hot flashes is thought to be related to its ability to increase serotonin levels in the brain, which helps regulate body temperature and reduce the frequency and intensity of hot flashes.
- Side effects of paroxetine may include nausea, headache, insomnia, or sexual dysfunction, but these often improve over time.
- It's essential to start at a lower dose and gradually increase if needed, and to continue the medication for at least 3-6 months before considering discontinuation, which should be done gradually to avoid withdrawal symptoms.
Comparison with Other Options
- Gabapentin, a γ-aminobutyric acid (GABA) analog, has been reported to moderate both the severity and duration of hot flashes, with a reduction in hot flash severity of 49% at 4 weeks and 46% at 8 weeks with a dose of 900 mg/d 1.
- Venlafaxine, a serotonin and norepinephrine inhibitor antidepressant, has also been shown to be effective in managing hot flashes, with significant declines in hot flash frequency and severity scores for all doses (37.5,75, and 150 mg) compared with placebo 1. However, paroxetine remains the most effective SSRI for treating hot flashes, with a more significant reduction in hot flash frequency and severity compared to other options.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Effective SSRIs for Treating Hot Flashes
The following SSRIs have been found to be effective in reducing the frequency and severity of hot flashes:
- Paroxetine (Paxil) 2, 3, 4, 5
- Citalopram (Celexa) 2, 4
- Escitalopram (Lexapro) 2, 6, 4
- Sertraline 4
- Fluoxetine 4
Efficacy of SSRIs
Studies have shown that SSRIs can reduce the frequency and severity of hot flashes by:
- 40.6% to 51.7% for paroxetine 5
- 62.2% to 64.6% for paroxetine CR 3
- A statistically significant decrease in hot flash frequency and severity compared to placebo 6
Comparison of SSRIs
Mixed treatment comparison analysis has demonstrated the superiority of escitalopram compared to other SSRIs in terms of efficacy 6. Venlafaxine and paroxetine have been studied more extensively and are more consistent in effectively reducing the frequency and severity of hot flashes 4.
Side Effects and Considerations
The most common side effects reported for SSRIs are nausea and constipation, with most resolving within the first week of treatment 2. Women with a history of breast cancer and taking tamoxifen should avoid SSRIs, which have been shown to interfere with tamoxifen metabolism 2.