Table 2.
Nonhormone Pharmacologic Therapies for Menopausal VMS
| Medication Name | Drug Class | Suggested Dosing | Side Effects | Additional Considerations |
|---|---|---|---|---|
| Gabapentin | Gamma-aminobutyric acid (GABA) analogue | 100–300mg 3x/day | Dizziness, fatigue | Consider in concomitant migraine or sleep disorders |
| Paroxetine | SSRI | Paroxetine mesylate: 7.5mg/day Paroxetine HCl: 10–20mg/day |
Nausea, dizziness | Only US FDA-approved nonhormone option. CYP2D6 inhibition; avoid in tamoxifen users; consider in concomitant mood disorders |
| Venlafaxine | SNRI | 37.5–150mg/day | Nausea, dizziness | May be safe in tamoxifen users |
| Oxybutynin | Anticholinergic, antimuscarinic | 2.5mg-5mg/2x daily up to 15mg/day | Dry mouth, urinary difficulties | Avoid in elderly; may benefit concomitant overactive bladder with VMS; side effects appear dose-dependent |
| Clonidine | Antihypertensive; α-2 adrenergic agonist | 0.05–0.15mg/day | Blood pressure, drowsiness, dry mouth | Inconsistent data; less effective than SSRIs/SNRIs and gabapentinoids; significant side effects |