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Treating hot flushes: An alternative
to hormonal replacement therapy
The Royal Women’s Hospital Fact Sheet / www.thewomens.org.au This fact sheet information describes non-hormonal medicines used for hot flushes. It should not replace the official product information.
Recent concerns about hormone treatments for menopause How long does it take to work?
symptoms (HRT) have led to increased interest in non-hormonal Generally hot flushes will reduce once 900mg daily dose therapies. Before starting any treatment, please tell your is reached. Use of 900mg daily has been found to be effective doctor or pharmacist if you are on other medicines or herbal in reducing menopausal hot flushes for at least 12 weeks products, as they may not mix well with your current medicines. In particular, please tell your doctor and pharmacist if you are How long is the treatment?
The length of treatment depends on your response to the What are hot flushes?
medicine. The decision must be made in partnership with your doctor. A hot flush is a sudden sensation of warmth spreading all What are the side effects?
over your body. Sometimes, you will also have sweating, Side effects include drowsiness, light-headedness and palpitations and anxiety. The severity and duration of dizziness. Please refer to the official product information symptoms vary widely among individuals - some women for a complete list of reported side effects.
may have minimal symptoms for a year or two, while others have symptoms for several years.
Clonidine
What non-hormonal medicines are used
Brand name: Catapress® available as 100micrograms and to reduce hot flushes?
The non-hormonal medicines used to reduce hot flushes in Clonidine is a medicine used to treat high blood pressure and women include gabapentin, clonidine, venlafaxine or selective prevent migraine headache. It is also a non-hormonal medicine serotonin reuptake inhibitors (SSRIs). The treatment option that has been shown to be effective in reducing menopausal hot flushes. Reports of studies related to clonidine treatment of hot flushes date back to the 19703.
Gabapentin
What is the usual dosage?
Brand name: Neurontin® available as 100mg, 300mg and You will start the dose at 25micrograms (a quarter of a 400mg capsules. Also available in generic brand.
tablet) twice a day. The dose can be increased as tolerated to 50-75micrograms twice a day over two weeks if necessary3. Gabapentin is usually used to control epilepsy or chronic nerve (neuropathic) pain. It is also a non-hormonal medicine that has How long does it take to work?
been shown to be effective in reducing menopausal hot flushes. If after two to four weeks there is no noticeable benefit, Gabapentin appears to be comparable with low dose oestrogen treatment should be stopped. You should also stop taking in reducing the frequency and severity of hot flushes1. it if you have significant side effects.
What is the usual dosage?
How long is the treatment?
You will generally start the dose at 300mg daily (preferably taken The length of treatment depends on your response to the as a single dose at night time because it can make you feel medicines, and is decided by your doctor. a little dizzy and sleepy). The dose can be increased by 300mg What are the side effects?
every 2-3 days until the recommended dose is reached, which Side effects include constipation, dry mouth, drowsiness is 300mg three times daily2. Higher doses of gabapentin (up to and difficulty in sleeping. Please refer to the official product information for a complete list of reported side effects.
Treating hot flushes: An alternative to hormonal replacement therapy – December 2010 D10-152 Venlafaxine
Selective serotonin reuptake inhibitors
Brand name: Efexor® available in 37.5mg, 75mg and 150mg modified release capsules.
Brand name: Prozac® (fluoxetine), Cipramil® (citalopram), Venlafaxine is a medicine mainly used as an antidepressant. and Aropax® (paroxetine), also available in generic brands.
It is also a non-hormonal medicine that has been shown The most commonly prescribed SSRIs for hot flushes at the to be effective in reducing menopausal hot flushes. Hot flushes decreased by 60% after 8 weeks of treatment • Fluoxetine available in 20mg capsules or tablets • Citalopram available in 20mg tablets What is the usual dosage?
• Paroxetine available in 20mg tablets You will start the dose at 37.5mg daily as a single dose. SSRIs are a class of medicines mainly used as antidepressants. The dose can be increased every four to seven days until SSRIs are also non-hormonal medicines that have been shown the recommended dose is reached, which is 75mg daily4, 5. to be effective in reducing menopausal hot flushes. Most Take venlafaxine with food once a day preferably at the studies have shown that low doses of SSRIs are effective in same time each day. Food may lessen any nausea feeling reducing menopausal hot flushes and women are less likely that the medicine may cause. Do not divide, crush, chew What is the usual dosage?
When venlafaxine is to be discontinued, gradually reduce the You will start with a low dose, increasing gradually over two dose over two weeks to minimise symptoms that can come to four weeks as tolerated. Most SSRIs are taken in the morning to minimise insomnia (sleeping difficulty), but if it How long does it take to work?
makes you sleepy it can be taken at night.
Symptom relief usually occurs within seven to fourteen When SSRIs are to be discontinued, gradually reduce the days. When changing from venlafaxine to an SSRI, wait dose over two weeks to minimise symptoms that can come for venlafaxine free period to prevent side effects due to drug interactions. Gradually withdraw venlafaxine over Citalopram - you will start the dose at 10mg (a half of a tablet) at least two weeks to avoid withdrawal symptoms. daily for one week, and then increase to 20mg daily. The How long is the treatment?
dose can be further increased up to 30mg daily if necessary6. The length of treatment depends on your response to the Citalopram may be taken with or without food once a day medicine, and is decided by your doctor. preferably at the same time each day.
What are the side effects?
Fluoxetine - you will start the dose 10mg (a half of a tablet) daily Side effects of venlafaxine include dry mouth, decreased for one week, and then increase to 20mg daily. The dose can appetite, nausea, constipation and sleeplessness. Side be further increased up to 30mg daily if necessary6. Fluoxetine effects are more common with higher doses. Please refer may be taken with or without food once a day preferably at the to the official product information for a complete list of Paroxetine - you will start the dose 10mg (a half of a tablet) daily for one week, and then increase to 20mg daily7. Take paroxetine with food once a day, preferably in the morning at the same time each day. It is as effective if you take between 10mg and 20mg doses, but research suggests that women are more likely to keep taking it if the doses are lower.7 Treating hot flushes: An alternative to hormonal replacement therapy – December 2010 D10-152 How long does it take to work?
references:
SSRIs may take six to eight weeks to have the full effects; 1. Reedy SY, Warner H, Jr TG, et al. Gabapentin, estrogen, and placebo however improvement is often seen within one to three for treating hot flushes: a randomized controlled trial. Obstet Gynecol weeks. When changing from one SSRI to another SSRI 2. Thomas Guttuso J, Kurlan R, McDermott MP, Kieburtz K. Gabapentin’s or venlafaxine, wait for SSRI-free period to prevent side effects on hot flashes in postmenopausal women: a randomized controlled trial. Obstet Gynecol 2003;101:337-45.
How long is the treatment?
3. Clayden JR, Bell JW, Pollard P. Menopausal flushing: double-blind trial If after four to six weeks there is no benefit, treatment of a non-hormonal medication. The British Medical Journal 1974;1:409-12.
4. Barton D, Vasseur BL, Loprinzi C, Novotny P, Wilwerding MB, Sloan should be stopped. Treatment should also be stopped if you J. Venlafaxine for the control of hot flashes: results of a longitudinal continuation study. Oncol Nurs Forum 2002;29:33-40.
What are the side effects?
5. Evans ML, Pritts E, Vittinghoff E, McClish K, Morgan KS, Jaffe RB. Management of postmenopausal hot flushes with venlafaxine hydrochloride: Side effects of SSRIs include nausea, drowsiness, tremor, a randomized, controlled trial. Obstet Gynecol 2005;105:161-6.
weight gain or loss. Side effects are more common with 6. Suvanto-Luukkonen E, Koivunen R, Sundström H, et al. Citalopram and higher doses. Please refer to the official product information fluoxetine in the treatment of postmenopausal symptoms: a prospective, for a complete list of reported side effects.
randomized, 9-month, placebo-controlled, double-blind study. Menopause 2005;12:18-26.
if you have any questions about the information
7. Stearns V, Slack R, Greep N, et al. Paroxetine is an effective treatment on this fact sheet, please contact:
for hot flashes: results from a prospective randomized clinical trial. Journal of Clinical Oncology 2005;23:6919-30.
For general information about menopause contact:
Women’s Health Information Centre (WHIC)
T: (03) 8345 3045 or 1800 442 007 (rural callers)
E: whic@thewomens.org.au
Disclaimer The Royal Women’s Hospital does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided in this fact sheet or incorporated into it by reference. We provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest hospital Emergency Department. The Royal Women’s Hospital, December 2010 Treating hot flushes: An alternative to hormonal replacement therapy – December 2010 D10-152

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