Treatment of hot flushes 2ry to Tamoxifen

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  • A clinical trial looked at the efficacy of gabapentin compared with venlafaxine, utilizing patient preference as its primary endpoint. 
  • Patients were randomly assigned to receive venlafaxine compared with gabapentin in relatively standard doses recommended by previous placebo-controlled clinical hot flash trials. 
  • Patients were treated for 4 weeks and then had a 2-week washout period, before being crossed-over to the alternative treatment. 
  • Although both agents appeared to reduce hot flashes to similar extents (approximately a 65% (reduction) and had similar amounts of toxicities, 68% of patients preferred venlafaxine compared with 32% who preferred gabapentin (p = 0.01). 
  • The authors concluded that venlafaxine should be recommended as an initial treatment but that some patients did better with gabapentin, supporting a trial of this medication if venlafaxine was not efficacious enough. 
  • In 2013, paroxetine was FDA-approved for the treatment of hot flashes. However, this drug should not be used with tamoxifen as it inhibits CYP2D6, the enzyme that converts tamoxifen to its more active form, endoxifen.

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