Non Hormonal Treatment of Hot Flashes

Hot flashes are usually described as a feeling of warmth or heat that starts in the face and neck and can travel down through the chest and can go all the way to the feet. This sensation of heat may be accompanied by a red face and perspiration. They are usually accompanied by emotional changes and behavioral consequences.

Emotions can include irritation, agitation, annoyance, embarrassment, distress, and panic. Behavior changes can include the need to change clothing, sleep disturbances, feeling a need to move outdoors and interfere with or stop work activities. Other symptoms can include difficulty sleeping, fatigue, interruption of sexual relations, sleepiness, nervousness and mood changes.

General Guidelines:

  • Some medications may not be appropriate based on patient's medical condition.
  • Over-the-counter medications containing estrogen should be avoided in women who have been diagnosed with breast cancer
  • Wear loosely woven, cotton fabrics
  • Dress in layers
  • Lower the thermostat/open the window/turn on a fan
  • Sip cool drinks/eat a Popsicle
  • Avoid caffeine, spicy foods, and alcohol
  • Exercise regularly
  • Learn relaxation techniques

Prescription Agents

  • Venlafaxine (Effexor), extended release 37.5 mg daily for 7 days then changed to 75 mg daily. It should not be used when high blood pressure is uncontrolled. It relieves hot flashes by 60 %. Improvements should be noted by the second week. Common side effects can include nausea and vomiting that improves over time, slight decrease in appetite, dry mouth.
  • Gabapentin (Neurontin), 300 mg at bedtime for 3 days then changed to 300 mg twice daily for3 days then increased to 300 mg three times per day. This is added to Venlafaxine. Reduces hot flashes by 50 %. Usually well tolerated with the main side effect of slight dizziness when first taken. If effective, some people may be slowly taken off of Venlaxafine by decreasing the dose by half every 4-5 days. Side effects of Gabapentin include fluid retention or edema leading to weight gain. Protein and albumin blood tests should be monitored if this happens. It is usually reversed when the medication is stopped.
  • Clonidine (Catapress-TTS), one 0.1 mg transdermal patch weekly. It reduces hot flashes by 33 %. Side effects are minimal, without significant changes in blood pressure or pulse.