A NON-HORMONAL DRUG — VEOZAH — IS EFFECTIVE against a primary symptom of menopause. This article explores a new hot flash medication, a newly approved oral medicine designed to treat menopausal hot flashes.
Menopausal hot flashes are a problem for many of my patients, including women going through menopause or men receiving some prostate cancer treatments.
First, we’ll examine the phenomenon of hot flashes: How common is it? What are common symptoms? When should you seek help from a healthcare professional?
What are Hot Flashes?
A hot flash is a sudden warmth sensation in the upper body. The feeling can be more intense over the face, neck, and chest. Many experience skin reddening, as if blushing.
Hot flashes can also cause sweating. For those who lose too much body heat, there can be a chilling sensation after the hot flash ceases. Hot flashes occurring at night are known as night sweats, a phenomenon that can disrupt sleep.
Johns Hopkins Medical Center (USA) characterizes menopausal hot flashes in this way:
“Hot flashes or flushes are, by far, the most common menopause symptom. Approximately three in four women have sudden, short-lived, intermittent increases in their body temperature. Typically, hot flashes begin before a woman’s last period.
For 80 percent, hot flashes occur for two years or less. A small percentage of women experience the symptom for over two years. These flashes appear directly related to diminishing estrogen levels; hot flashes vary in frequency and intensity for each woman.”
Other Hot Flash Symptoms
During a hot flash, you might experience the following symptoms:
- A sudden warmth sensation spreads through your chest, neck, and face
- A flushed appearance with red and blotchy skin
- Rapid heartbeat
- Sweating, mostly on your upper body
- A chilled feeling as the hot flash eases
- Anxiety
The intensity and frequency of hot flashes vary among women. A single episode may last a minute or two — or as long as five minutes.
Hot Flash Management: Medicines
Menopause is the primary cause of hot flashes, although other medical conditions can be causative. As menstrual periods become irregular and ultimately cease, hot flashes can emerge.
Hot flashes, or vasomotor symptoms, affect approximately 75 percent of menopausal and perimenopausal American women. The symptoms can very negatively affect the quality of life and productivity.
There are a variety of management approaches for bothersome hot flashes. Hormone therapy is the most effective treatment for women under 60, but it presents risks for women with certain health conditions.
Here is Dr. Stephanie Faubiom, medical director for the North American Menopause Society and a director of the Mayo Clinic Center for Women’s Health, speaking to the New York Times:
We do not have many safe and effective management tools for hot flashes. While hormone therapy (such as estrogen, with or without progesterone) can be remarkably effective for women under 60, women with certain health conditions (including my patients with hormonally-driven breast cancer) are not good candidates for the approach.
Moreover, a 2002 landmark study led to many misconceptions about hormonal treatment, leading many women to dodge it.
Only one non-hormonal treatment effectively manages hot flashes — paroxetine (a selective serotonin-reuptake inhibitor or SSRI). The medicine has the trade names Aropax, Paxil, Pexeva, Seroxat, Sereupin, and Brisdelle.
This medicine is for depression, but the US Food and Drug Administration also approved it for treating menopausal symptoms.
A 2005 randomized study showed these results:
Paroxetine 10 milligrams (mg) dropped hot flash frequency by 41 percent, compared with 14 percent for placebo. Paroxetine 20 mg reduced hot flash frequency by 52 percent, compared with 27 percent for placebo.
While the ten and 20-milligram doses of paroxetine appeared similarly effective, women were less likely to stop taking the lower dose of paroxetine. Moreover, paroxetine 10 mg appeared to be associated with more improvement in sleep than a placebo.
The study authors concluded that paroxetine is an effective treatment for hot flashes in women with or without prior breast cancer. However, caution is advised.
Hot Flash Management: A New, Effective Medicine
Enter Veozah, produced by the Japanese pharmaceutical company Astellas. Approximately ten years ago, researchers discovered brain nerve cells — KNDy neurons — that regulate body temperature. The neurons appeared to be mostly under the control of estrogen.
As women transition to menopause, estrogen levels drop, and the KNDy neurons become overactive. The body then perceives itself as too hot, setting off a series of events designed to cool the body, including sweating.
Veozah contains fezolinetant, a compound that binds to the KNDy neurons, calming the nerve cells.
The drug manufacturer Astellas completed three clinical trials in Canada, the United States, and Europe. The studies included over 3,000 women with moderate to severe hot flashes. Women ranged in age from 40 to 65. Here are the results:
Compared to a placebo, the drug significantly reduced the severity and frequency of hot flashes for women taking one pill daily.
The new drug appeared effective across the age range of participants. This finding is important, as hormonal can be more risky for women over 60.
Women Have Been Misled About Menopause
Hot flashes, sleeplessness, pain during sex: For some of menopause’s worst symptoms, there’s an established treatment.www.nytimes.com.
Many Veozah study participants reported hot flash improvements within four weeks. Moreover, the drug seems similarly effective across many demographics, including race.
Who Should Not Take Veozah?
Veozah is contraindicated for women with these conditions:
- Cirrhosis of the liver
- Severe kidney impairment or end-stage renal disease
- Concurrent use of CYP1A2 inhibitor drugs. CYP1A2 metabolizes many drugs, such as caffeine, phenacetin, tacrine, clozapine, propranolol, and mexiletine.
According to the manufacturer, the most common side effects of Veozah include abdominal pain (4.3 percent versus 2.1 percent for placebo), diarrhea (3.9 versus 2.6 percent), insomnia (3.9 versus 1.8 percent), and back pain (3 versus 2.1 percent).
Other adverse reactions include hot flashes (2.5 versus 1.6 percent) and elevations of liver enzymes (2.3 versus 0.8 percent). Of course, given the drug is new, there are a lot of unknowns regarding toxicities.
The New York Times reports that the drug should be available within a few weeks. Unfortunately, Veozah is not cheap: It will cost $550 for a 30-day supply. We shall see if insurance companies in the United States will cover the cost.
Other hot flash management tools
While Veozah appears promising, here are some other tools for the management of hot flashes:
- Dress in layers that you may take off with a hot flash.
- Use a portable fan when a hot flash strikes.
- Avoid spicy foods, alcohol, and caffeine. These substances may make your hot flashes worse.
- Don’t smoke.
- Try to maintain a healthy weight, as being overweight can exacerbate hot flashes.
- Consider mind-body practices such as hypnotherapy. Some research suggests that mindfulness practices such as hypnotherapy and meditation can improve hot flashes.
Hot Flashes: What Can I Do?
Hot flashes, a common symptom of the menopausal transition, are uncomfortable and can last many years. www.nia.nih.gov.
When to see a doctor
If hot flashes affect your daily activities or nighttime sleep, please consider seeing your healthcare provider to discuss management options.
If you know someone with breast cancer, here is my comprehensive online course:
Breast Cancer – What a Patient Needs to Know.
Breast cancer information can be incredibly valuable for navigating breast cancer management.breastcancerbydrhunter.thinkific.com.
The information I provided in this blog is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider for medical advice, diagnoses, or treatment. I am not liable for risks or issues associated with using or acting upon the information in this blog.
Thank you for reading “A New Hot Flash Medicine.”
