How fezolinetant advances non-hormonal treatment of hot flashes

In a recent interview with Contemporary OB/GYN, Nanette Santoro, MD chair of obstetrics and gynecology at the University of Colorado School of Medicine, discussed fezolinetant, a novel non-hormonal treatment for menopause-related hot flashes.

Fezolinetant represents a significant advancement in managing hot flashes, acting similarly to estrogen by targeting specific receptors in the brain's KNDy neurons that regulate the body’s temperature. Unlike traditional hormonal therapies, fezolinetant is ideal for individuals unable or unwilling to use hormones.

Santoro highlighted fezolinetant's effectiveness, with clinical trials showing a 75% to 80% reduction in the frequency and severity of hot flashes. This treatment specifically decreases moderate-to-severe hot flashes, which significantly impact daily life. Unlike alternatives such as antidepressants or gabapentin, which often cause off-target side effects, fezolinetant targets action on neurokinin receptors. This avoids issues associated with using antidepressants to treat hot flashes, such as changes in mood, sexual side effects, and stomach side effects.

Side effects of fezolinetant are relatively mild, including headaches and nausea in a small percentage of patients. However, approximately 2% to 3% of users may experience elevated liver enzymes, necessitating liver function monitoring during the first 9 months of treatment. The FDA recommends monitoring liver function after 3 months, 6 months, and 9 months.

Fezolinetant is particularly beneficial for women with contraindications to hormonal therapies, such as those with a history of breast cancer or blood clots. However, it is not suitable for individuals requiring broader symptom relief, such as vaginal dryness, which hormones better address.

Patients should be cautious about drug interactions, as fezolinetant is metabolized by the liver enzyme CYP 1A2. Certain medications, such Pepcid or antiviral drugs, can increase CYP 1A2 levels, potentially leading to side effects. This makes it essential to consult health care providers before introducing new medications.

Santoro emphasizds that fezolinetant’s approval paves the way for similar treatments targeting the same receptors, offering hope for expanding non-hormonal options for menopausal symptom management in the future.