Non-hormonal options for vasomotor symptoms
Also known as:
NK receptor antagonists, SSRIs, SNRIs, gabapentin
Evidence and monitoring for fezolinetant, elinzanetant, paroxetine and other non-hormonal therapies.
Written and reviewed by Farhan Tahir, MD · Last reviewed
VIDEO LESSON
NK receptor antagonists
• Fezolinetant 45 mg daily (NK3): check liver tests before starting and during the first months as the label directs; the label carries a boxed warning for liver injury
• Elinzanetant 120 mg nightly (NK1 and NK3): improves vasomotor symptoms and associated sleep disturbance
Other medicines
• Paroxetine mesylate 7.5 mg nightly (FDA-approved for VMS); avoid with tamoxifen because of CYP2D6 inhibition
• Venlafaxine, desvenlafaxine, escitalopram and citalopram
• Gabapentin at bedtime, helpful for night sweats
• Oxybutynin, weighing anticholinergic burden in older adults
Behavioral
CBT and clinical hypnosis are recommended. The Menopause Society does not recommend most supplements, paced respiration or compounded hormones.
Clinical pearls
Choose by comorbidity: an SNRI for coexisting depression, gabapentin for poor sleep, an NK antagonist when serotonergic drugs are unsuitable.
Key studies and references
Educational content only, written and reviewed by Farhan Tahir, MD. It does not replace individual medical advice. For sudden chest pain, trouble breathing or stroke symptoms, call 911.
AT A GLANCE
Section
Prescribing
Also known as
NK receptor antagonists, SSRIs, SNRIs, gabapentin
Reviewed by
Farhan Tahir, MD
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