Will Venlafaxine Become a First-Line Treatment for Hot Flashes?

The nonhormonal treatment venlafaxine was nearly as effective as low-dose oral estrogen in reducing hot flashes and night sweats in menopausal women, according to research published in JAMA Internal Medicine.

A randomized placebo-controlled trial found that venlafaxine, an antidepressant, could be used as a first-line treatment in women who are unwilling or unable to use low-dose estrogen therapy. 

Pertinent Points

- The nonhormonal treatment venlafaxine was nearly as effective as low-dose oral estrogen in reducing hot flashes and night sweats in menopausal women.

- While estrogen still outperformed venlafaxine, the study authors concluded that the difference was slight and likely to be of clinical relevance.

- Treatment satisfaction was highest among women who received low-dose estrogen.

"Our new findings provide critical data for physicians and women making treatment decisions for hot flashes/night sweats,” said Hadine Joffe, MD, MSc, director of the Women's Hormone and Aging Research Program at Brigham and Women’s Hospital, and lead author of the paper, in a news release. “Our data show that first-line hormonal and nonhormonal pharmacological treatments are well-tolerated and effective options for alleviating symptoms."

The alternative is important to clinical treatment given the concern surrounding the risks associated with estrogen that led to the current recommendations that estrogen therapy be used only at the lowest possible dosage for the shortest possible duration, Joffe noted.

For the study, 339 perimenopausal and postmenopausal women with bothersome vasomotor symptoms were enrolled for 8 weeks of treatment.

Those given estradiol saw hot flashes and night sweats decrease by 52.9% on average, compared with a decrease of 47.6% among patients given venlafaxine. Those who received a placebo had a 28.6% reduction in hot flashes and night sweats.

On average, estradiol reduced the frequency of symptoms by 2.3 more per day than placebo (P < 0.001), and venlafaxine reduced the frequency of symptoms by 1.8 more per day than placebo (P = 0.005).

While estradiol was superior in reducing symptoms, the researchers concluded that the difference was small and “of uncertain clinical relevance.” Still, treatment satisfaction was highest (70.3%) for estradiol (P < 0.001 vs placebo) and lowest (38.4%) for placebo. Among women given venlafaxine, 51.1% reported being satisfied with the treatment.