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Sixty-six women with histories of breast cancer were randomly assigned in an open-label fashion to receive venlafaxine or gabapentin for 4 weeks; after a 2-week washout period, they received the opposite treatment for an additional 4 weeks.Both treatments reduced hot flash scores (severity multiplied by frequency) by about 66%.Women who are extensive metabolizers of tamoxifen related to CYP2D6 may have more severe hot flashes than women who are poor metabolizers.[1] Estrogen replacement effectively controls hot flashes associated with biologic or treatment-associated postmenopausal states in women.The proposed mechanism of action of estrogen replacement therapy is that it ameliorates hot flashes by raising the core body temperature sweating threshold;[1][Level of evidence: I] however, many women have relative or absolute contraindications to estrogen replacement.When specific information about the care of children is available, it is summarized under its own heading.Causes of menopausal hot flashes include the occurrence of natural menopause, surgical menopause, or chemical menopause; in the cancer patient, chemical menopause may be caused by cytotoxic chemotherapy, radiation therapy, or androgen treatment.

We are certified and licensed with the Ministry of...Trazodone, an atypical antidepressant that is often used as a sleeping aid, has anecdotally been shown to be particularly helpful in patients with nocturnal hot flashes. Clinical experience suggests that trazodone can help patients fall asleep and can control hot flashes during the night, helping them to stay asleep.Trazodone is a tricyclic antidepressant and, as such, would not be expected to have a great impact on hot flashes: one open-label pilot trial conducted with a tricyclic antidepressant, desipramine, as a proof-of-principle study did not show a benefit.[27] However, this study has not been replicated.Inferior efficacy, lack of large definitive studies, and potential side effects limit the use of many of these agents.[9-11][Level of evidence: I] Agents that have been found to be helpful in large, randomized, placebo-controlled clinical trials include venlafaxine, paroxetine, citalopram, fluoxetine, gabapentin, pregabalin, and clonidine.[9-11] These agents demonstrate a 40% to 60% reduction in hot flash frequency and score (a measure combining severity and frequency).[12] Agents conferring a 55% to 60% reduction in hot flashes are venlafaxine extended release, 75 mg daily;[13] paroxetine, 12.5 mg controlled release [14] or 10 mg daily;[15] gabapentin, 300 mg tid;[16,17][Level of evidence: I];[18][Level of evidence: II] and pregabalin, 75 mg bid.[19][Level of evidence: I] Other effective agents resulting in about a 50% reduction in hot flashes include citalopram, 10 to 20 mg per day, which was studied in clinical trial NCCTG-N05C9;[20][Level of evidence: I] and fluoxetine, 20 mg per day.[10] Clonidine, 0.1 mg transdermal [21] or oral daily,[22][Level of evidence: I] can reduce hot flashes by about 40%.One study compared the efficacy and patient preference of venlafaxine, 75 mg, once daily to gabapentin, 300 mg, 3 times per day for the reduction of hot flashes.

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Physicians and breast cancer survivors often think there is an increased risk of breast cancer recurrence or de novo breast malignancy with hormone replacement therapies and defer hormonal management of postmenopausal symptoms.

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