Table 1. Effectiveness of different interventions for hot flashes.
Agent | Dose | % of Patients in Active Arm with ≥50% Decrease in Baseline Hot Flash Score136,137 |
% of Patients in Placebo Arm with ≥50% Decrease in Baseline Hot Flash Score136,137 |
Other Outcomes More Common in Active Arm vs Placebo |
---|---|---|---|---|
MPA138 | 400 mg intramuscularly |
72 | Comparison with venlafaxine |
No placebo data |
Megestrol acetate12 |
20 mg BID | 63 | 30 | Withdrawal menstrual bleeding |
Venlafaxine139 Venlafaxine139 Venlafaxine139 |
37.5 mg/d 75 mg/d 150 mg/d |
54 70 62 |
30 | Nausea, appetite loss, dizziness, constipation, dry mouth, sleepiness, improved quality of life |
Fluoxetine140 | 20 mg/d | 70 | 52 | None |
Paroxetine CR141 | 12.5 mg/d | 50 | 49 | None |
Paroxetine CR141 | 25 mg/d | 68 | None | |
Paroxetine142 | 10 mg/d | 70 | 33; 57a | No side effects. Improved sleep |
Paroxetine142 | 20 mg/d | 76 | Nausea | |
Sertraline143-144 | 50 mg/d | 40–50 | 21–38 | Nausea, fatigue, diarrhea, anxiety |
Sertraline145 | 100 mg/d | 56 | 41 | Nausea |
Gabapentin14 Gabapentin14,146 |
300 mg/d 900 mg/d |
46 56–63 |
27 27–38 |
Decrease in appetite, decrease in pain |
Gabapentin147 | 2400 mg/d | 84 | 47 | Trend toward more headache, dizziness, disorientation, sleep disturbance |
Clonidine16 | 0.1 mg/d oral or patch |
37 | 30 | Difficulty sleeping, dry mouth, constipation, skin rash from patch, improved quality of life |
Vitamin E148 | 800 IU/d | 32 | 30 | None |
Soy149 | 70–150 mg isoflavones/d |
30 | ? | None |
Black cohosh150 | 20 mg/d | 20 | 30 | None |
All agents were compared with placebo unless otherwise noted.
This study had two placebo arms.
Data from Loprinzi CL, Barton DL, Sloan JA, et al. Mayo Clinic and North Central Cancer Treatment Group hot flash studies: a 20-year experience. Menopause 2008;15(4 Pt 1):655–60; and Loprinzi CL, Sloan J, Stearns V, et al. Newer antidepressants and gabapentin for hot flashes: an individual patient pooled analysis. J Clin Oncol 2009;27(17):2831–7.