Prescribing VEOZAH in Patients with Hypertension
VEOZAH (fezolinetant) can be prescribed for moderate to severe vasomotor symptoms of menopause in patients with hypertension, as it is a non-hormonal neurokinin 3 receptor antagonist that does not directly affect blood pressure control. 1, 2
What is VEOZAH?
VEOZAH is an oral, non-hormonal medication approved by the FDA for treating moderate to severe hot flashes and night sweats (vasomotor symptoms) associated with menopause. 1 It works by blocking neurokinin 3 receptors in the central nervous system that regulate thermoregulation, without using hormones. 1, 2
Hypertension Management Considerations
When prescribing VEOZAH to patients with hypertension, you must ensure their blood pressure is adequately controlled with appropriate antihypertensive therapy:
First-Line Antihypertensive Options
For most patients with hypertension, initiate treatment with thiazide or thiazide-like diuretics, ACE inhibitors, ARBs, or calcium channel blockers. 3
Non-black patients: Start with low-dose ACE inhibitor or ARB (such as losartan, lisinopril, or valsartan), increase to full dose if needed, then add a thiazide/thiazide-like diuretic, followed by a CCB if blood pressure remains uncontrolled. 3, 4
Black patients: Begin with low-dose ARB plus dihydropyridine CCB, or CCB plus thiazide/thiazide-like diuretic, increase to full dose, then add the remaining class not initially used. 3
Patients with diabetes or chronic kidney disease: ACE inhibitors or ARBs are preferred, particularly if albuminuria is present. 3
Target Blood Pressure
Aim for blood pressure <130/80 mmHg in most patients with hypertension. 3 In patients with heart failure and reduced ejection fraction, target <130/80 mmHg, with consideration for <120/80 mmHg in select cases. 5
Key Clinical Considerations
Combination Therapy Approach
Most patients with established hypertension benefit from upfront low-dose combination therapy, preferably as single-pill combinations. 3 This approach improves adherence and achieves blood pressure goals more rapidly than sequential monotherapy.
Medications to Avoid in Specific Populations
If your patient has heart failure with reduced ejection fraction in addition to hypertension, avoid:
- Nondihydropyridine CCBs (verapamil, diltiazem) due to negative inotropic effects 5
- Clonidine and moxonidine due to increased mortality risk 5
- Alpha-blockers (doxazosin) except as last-line therapy 5
Monitoring Requirements
When prescribing VEOZAH alongside antihypertensive therapy:
- Monitor liver function tests, as fezolinetant requires hepatic monitoring 2
- Continue routine blood pressure monitoring to ensure hypertension remains controlled
- If using aldosterone antagonists (spironolactone, eplerenone), monitor serum potassium and creatinine frequently, especially when combined with ACE inhibitors or ARBs 5
Clinical Pitfalls to Avoid
Do not combine ACE inhibitors with ARBs, as this increases adverse effects without additional benefit. 3 Choose one or the other based on patient tolerance and response.
Avoid short-acting dihydropyridine CCBs (immediate-release nifedipine) as they can cause severe hemodynamic instability; use only long-acting formulations. 5
NSAIDs should be used cautiously in hypertensive patients, as they can elevate blood pressure, cause fluid retention, and worsen renal function. 5