Table 4.

Nonhormonal Treatments of Vasomotor Symptoms

MedicationSORComments
SSRIs36,37A (Systematic review and meta-analysis)

  • · Paroxetine is the only nonhormonal medication approved by the FDA for hot flashes.

  • · Paroxetine should not be used in people taking tamoxifen

  • · Systematic review suggests that escitalopram is superior to other SSRIs36

  • · Another systematic review documented the benefit of escitalopram, paroxetine, and fluoxetine over other SSRIs40

  • · May be limited by side effects

SNRIs40A (systematic review and meta-analysis)

  • · Good evidence for the benefit of venlafaxine and desvenlafaxine.  Not enough studies to evaluate benefit of duloxetine.40,44 

Fezolinetant41 (Neurokinin receptor antagonist)A (systematic review and meta-analysis)Fair evidence for benefit over placebo. Most studies were small but showed no significant adverse effects.
Gabapentin38A (systematic review)

  • · Good evidence for gabapentin, but not enough studies on pregabalin.35,38 

  • · May be limited by side effects

  • · Effective dose not clear

Clonidine34,35B (randomized controlled trials)

  • · Limited by side effects

  • Abbreviations: SSRIs, Selective Serotonin Reuptake Inhibitors; SNRIs, Serotonin-Norepinephrine Reuptake Inhibitors; FDA, Food and Drug Administration