Does Paroxetine Cause Hot Flashes?
No, paroxetine does not cause hot flashes—it is an FDA-approved treatment that effectively reduces them. Paroxetine mesylate 7.5 mg is the only nonhormonal medication with FDA approval specifically for treating moderate-to-severe vasomotor symptoms in menopausal women 1, 2.
Efficacy for Hot Flash Treatment
Paroxetine reduces hot flashes by 62-67% compared to placebo's 13.7-38% reduction 3, 1, 4, 2. The evidence demonstrates:
- Low-dose paroxetine (7.5-12.5 mg daily) is the optimal starting dose, providing 62% reduction in hot flash composite scores with the best tolerability profile 1
- Higher doses (20-25 mg) offer no additional benefit but significantly increase side effects and discontinuation rates 1
- Paroxetine 10 mg reduces hot flash frequency by 40.6% and severity scores by 45.6%, compared to 13.7% with placebo 4
- Symptom improvement occurs within 4 weeks; if no response by then, the medication is unlikely to be effective 1
Important Clinical Caveat: Tamoxifen Interaction
Paroxetine is explicitly contraindicated in breast cancer patients taking tamoxifen due to potent CYP2D6 inhibition, which blocks conversion of tamoxifen to its active metabolite endoxifen 1. For tamoxifen users, alternative options include:
- Venlafaxine 37.5-75 mg daily (61% reduction in hot flashes) 3, 1
- Sertraline 50 mg daily (minimal CYP2D6 effects) 5, 1
- Citalopram 5, 1
- Gabapentin 900 mg at bedtime 1
Paradoxical Worsening: A Rare Occurrence
While paroxetine treats hot flashes, there is marked individual variability with some women experiencing exacerbation of vasomotor symptoms 3. In one study of fluoxetine (a related SSRI), 27% of patients had worse hot flashes despite treatment 3. This underscores the need for a trial period to assess individual response, though this adverse reaction appears uncommon with paroxetine specifically.
Dosing Strategy
Start with paroxetine 7.5 mg daily at bedtime 1. This FDA-approved dose provides:
- Significant symptom reduction (62-65% improvement) 1
- Best tolerability profile 1
- Lower discontinuation rates compared to higher doses 1
The controlled-release formulation at 12.5 mg daily is an alternative that achieves similar efficacy 3, 1.
Common Side Effects
Dose-dependent adverse effects include nausea, fatigue, dizziness, headache, dry mouth, insomnia, and sexual dysfunction 1. These are typically mild-to-moderate, with 10-20% of patients withdrawing due to adverse events—less likely with lower doses 1, 2.
Discontinuation Protocol
Paroxetine must be tapered gradually to prevent discontinuation symptoms, as it is a short-acting agent particularly prone to withdrawal effects 3.