Table 1. SSRIs for HFs.

Type of drug and dose	Effectiveness	Side effects	Interactions with tamoxifen
Paroxetine 10–25 mg/day (7.5 mg salt is the only SSRIs/SNRIs approved for the treatment of menopausal moderate-to-severe HFs by FDA) (first-line option for HFs) [15, 16, 17, 21, 23]	Up to 64% HFs score reduction, improvement also of sleep	Nausea at the 20 mg dose The low dosage has less toxicity low withdrawal rate, in particular, with low doses	Potent inhibitors of CYP2D6 enzyme; they should be avoided during tamoxifen use
Fluoxetine 10–30 mg/day (second-line option for HFs) [16, 17, 21, 22]	24% HFs score and 19% HFs frequency reduction	18% withdrawal rate withdrawal due to more ineffectiveness of treatment rather than to side effects
Sertraline 25–100 mg/day (second-line option for HFs) [16, 17, 21]	Modest effect on HFs	10% dropout rate nausea and decreased sexual function	Moderate effect on the CYP2D6 enzyme
Citalopram 10–20 mg/day (first-line option for HFs) [16, 17]	Up to 49%–55% HFs score reduction	20% withdrawal rate	Mild inhibitory effect on the CYP2D6 enzyme; they can be used in tamoxifen users
Escitalopram 10–20 mg/day (first-line option for HFs) [16, 17]	47% HFs frequency and 24% reduction	Best tolerability profile withdrawal rate of 4% nausea, weakness and drowsiness

SSRIs = selective serotonin reuptake inhibitors; SNRIs = selective serotonin-norepinephrine reuptake inhibitors; FDA = Food and Drug Administration; HFs = hot flushes