Table 2. SNRIs for HFs.

Type of drug and dose	Effectiveness	Side effects	Interaction with tamoxifen
Duloxetine 30–120 mg/day (first-line option for HFs) [16]	56% HFs frequency and 62% HFs score reduction	Nausea, weakness, drowsiness, insomnia, mouth dryness and constipation	Moderate effect on the CYP2D6 enzyme
Venlafaxine 37.5–150 mg/day (first-line option for HFs) [16, 17, 21, 24, 25]	Immediate effect and strong HFs reduction, up to 30%–58% reduction in HFs frequency and 37%–61% in the HFs score	Nausea, constipation, dry mouth, headache, sleeplessness and decreased appetite	Low inhibitory effect on the CYP2D6 enzyme; they are the safest choices in tamoxifen users
Desvenlafaxine 100–150 mg/day (first-line option for HFs) [15, 16, 17, 21]	60%–66% HFs frequency and 24%–29% HFs severity reduction, already in the first week of treatment	Only in the first week of treatment (nausea, dizziness and headache)

SNRIs = selective serotonin-norepinephrine reuptake inhibitors; HFs = hot flushes