Can You Take Veozah with an Estrogen Patch?
Yes, you can take Veozah (fezolinetant) with an estrogen patch, as Veozah is a non-hormonal medication that works through a completely different mechanism than hormone therapy and has no known drug interactions with estrogen. 1, 2
Mechanism and Compatibility
Veozah is a neurokinin 3 receptor (NK3R) antagonist that works centrally in the brain to modulate thermoregulation neurons, providing a non-hormonal approach to treating vasomotor symptoms. 2
Estrogen patches deliver 17β-estradiol transdermally, bypassing first-pass hepatic metabolism and providing physiologic hormone replacement. 3, 4
These two medications operate through entirely separate pathways: Veozah blocks NK3R signaling in the hypothalamus while estrogen acts through estrogen receptors throughout the body, meaning there is no pharmacologic basis for interaction. 1, 2
Clinical Scenarios Where Combination May Be Appropriate
Women who have partial symptom relief with estrogen patches alone but continue to experience breakthrough hot flashes may benefit from adding Veozah. 1
Women using low-dose estrogen patches primarily for bone health or urogenital symptoms who need additional vasomotor symptom control could use both therapies. 3, 5
Women with contraindications to higher-dose estrogen therapy may use low-dose patches for specific indications while relying on Veozah for vasomotor symptom management. 1
Important Monitoring Considerations
Veozah requires baseline liver function testing before initiation and monitoring at 3,6, and 9 months, then periodically thereafter, as it can cause dose-dependent elevations in hepatic transaminases. 1
This liver monitoring requirement is independent of estrogen patch use and must be performed regardless of concurrent hormone therapy. 1
Transdermal estrogen patches do not require routine laboratory monitoring unless clinically indicated by specific symptoms. 6
Practical Implementation
Either medication can be started first, or both can be initiated simultaneously, as there are no titration concerns related to their combination. 1, 2
Standard dosing applies for both: estrogen patches typically deliver 50-100 μg daily, while Veozah is dosed at 45 mg once daily. 6, 1
Women with an intact uterus using estrogen patches must also receive appropriate progestin therapy (such as micronized progesterone 200 mg for 12-14 days monthly or medroxyprogesterone acetate 10 mg for 12-14 days monthly) for endometrial protection, regardless of Veozah use. 7, 6