Veozah, with the active ingredient fezolinetant, is a non-hormonal prescription medication approved to treat moderate to severe hot flashes and night sweats associated with menopause. It works by blocking the neurokinin 3 (NK3) receptor in the brain to help regulate body temperature. While this offers a valuable new treatment option, it is critical to be aware of the drug and substance interactions that can impact its safety and effectiveness. The most significant interactions are related to the liver's cytochrome P450 1A2 (CYP1A2) enzyme, which is responsible for breaking down Veozah. Taking Veozah with any substance that inhibits this enzyme can cause dangerously high levels of fezolinetant in the body.
Contraindicated Medications: Strong and Moderate CYP1A2 Inhibitors
Certain medications are absolutely contraindicated, meaning they should not be taken with Veozah under any circumstances. These drugs are potent inhibitors of the CYP1A2 enzyme, and combining them with Veozah can lead to a drastic increase in the concentration of fezolinetant in the body. This substantially elevates the risk of severe side effects, especially liver problems.
Some of the most prominent contraindicated medications include:
- Fluvoxamine: A strong CYP1A2 inhibitor used to treat obsessive-compulsive disorder (OCD). Combining it with Veozah is known to cause a massive increase in Veozah exposure, with clinical studies showing an increase in systemic exposure (AUC) by 840%.
- Mexiletine: An antiarrhythmic drug used to treat irregular heart rhythms. As a moderate CYP1A2 inhibitor, it can also significantly increase fezolinetant exposure.
- Ciprofloxacin: A commonly prescribed antibiotic. As a moderate CYP1A2 inhibitor, its use with Veozah should be avoided.
- Cimetidine: A weak CYP1A2 inhibitor, and an H2 receptor blocker used to reduce stomach acid. Although a weak inhibitor, it can still double the exposure of fezolinetant.
Other Medications, Supplements, and Substances to Avoid
Beyond the primary CYP1A2 inhibitors, other drugs and substances can also interfere with Veozah and increase the risk of side effects. Always discuss all medications and supplements with your healthcare provider or pharmacist before starting Veozah.
- Hormonal Contraceptives: Combined hormonal birth control pills containing estrogens like ethinyl estradiol can slow down the CYP1A2 enzyme's activity. This can cause Veozah to build up in the system, raising the risk of side effects.
- Acetaminophen (Tylenol): While an occasional dose may be acceptable, taking large amounts or combining it with Veozah carries a higher risk of liver damage. Both substances are processed by the liver, and the cumulative stress can be harmful.
- Alcohol: Excessive alcohol consumption should be avoided. Like Veozah, large amounts of alcohol can strain the liver. Furthermore, alcohol can trigger hot flashes and night sweats, directly counteracting the treatment's purpose.
- Caffeine: Found in coffee, tea, and energy drinks, caffeine is also a CYP1A2 inhibitor and is contraindicated for use with Veozah. It can increase Veozah levels and amplify side effects.
- Herbal and Other Supplements: The dietary supplement market is not strictly regulated, and many products can interact with medications. Some examples include piperine (from black pepper extract) and cannabidiol (CBD), which inhibit the CYP1A2 enzyme. Always consult a healthcare professional before taking any herbal remedies or vitamins with Veozah.
Comparison of Key Veozah Interactions
| Substance Type | Specific Example | Interaction with Veozah | Risk to Patient |
|---|---|---|---|
| Strong CYP1A2 Inhibitor | Fluvoxamine (Luvox) | Significantly increases fezolinetant concentration (840% AUC increase). | High risk of serious side effects, including liver injury. |
| Moderate CYP1A2 Inhibitor | Mexiletine (Mexitil) | Increases fezolinetant concentration (360% AUC increase). | Increased risk of side effects. |
| Weak CYP1A2 Inhibitor | Cimetidine (Tagamet HB) | Increases fezolinetant concentration (100% AUC increase). | Increased risk of side effects. |
| Hormonal Contraceptives | Ethinyl estradiol/desogestrel | Inhibits CYP1A2, increasing Veozah levels. | Increased risk of Veozah side effects. |
| Over-the-Counter Analgesic | Acetaminophen (Tylenol) | Both processed by the liver, can increase liver stress. | Increased risk of liver injury, especially at high doses or with heavy alcohol use. |
| Dietary Substance | Caffeine | Inhibits CYP1A2, increasing Veozah concentration. | Increased risk of Veozah side effects and can trigger hot flashes. |
| Lifestyle Substance | Alcohol | Contributes to liver damage and can trigger hot flashes. | Higher risk of liver problems, reduced effectiveness against hot flashes. |
Pre-existing Health Conditions and Precautions
Certain medical conditions can make taking Veozah unsafe, even without interacting drugs. Patients with these conditions should not take Veozah.
- Liver Disease: Because Veozah is processed by the liver and carries a risk of liver injury, it should not be used by those with severe liver problems or cirrhosis.
- Kidney Problems: The kidneys help eliminate Veozah from the body. Severe kidney problems or kidney failure can lead to the drug accumulating in the system, increasing side effect risk.
Monitoring and Symptoms of Liver Injury
Due to the risk of liver injury, patients must undergo regular liver function blood tests while taking Veozah. Testing is typically done before treatment, monthly for the first three months, and then at months six and nine. Report any signs of liver problems to a healthcare provider immediately, such as:
- Unusual tiredness or fatigue
- Nausea or vomiting
- Unexplained itching
- Stomach pain, particularly in the upper right abdomen
- Yellowing of the skin or eyes (jaundice)
- Dark urine or pale stools
Final Recommendations for Safe Usage
Safe medication management requires transparency and careful oversight. Always provide your healthcare provider and pharmacist with a complete list of all medications, including prescriptions, over-the-counter drugs, vitamins, and herbal supplements. Never start, stop, or change the dosage of any medication without consulting your healthcare provider, especially when taking a medication with significant interaction potential like Veozah. If you experience any symptoms that could indicate a liver problem, discontinue use and seek immediate medical attention. For more information, visit the official Veozah website.
Conclusion
Veozah offers an effective non-hormonal treatment for menopausal hot flashes, but its safety hinges on avoiding specific interactions. The primary risk lies with medications and substances that inhibit the CYP1A2 enzyme, such as fluvoxamine, mexiletine, and ciprofloxacin, which are strictly contraindicated. Furthermore, common items like alcohol, caffeine, and acetaminophen should be used with caution due to their impact on liver health and potential to worsen menopausal symptoms. Diligence in managing all co-administered substances and regular liver monitoring, as guided by a healthcare provider, are essential for minimizing risks and ensuring a positive treatment outcome with Veozah.
