The Critical Importance of Hepatic Monitoring
Veozah, or fezolinetant, is a prescription medication for moderate to severe menopausal hot flashes. It acts as a neurokinin 3 (NK3) receptor antagonist in the brain to regulate body temperature. Due to a risk of liver injury, the FDA has included a Boxed Warning for Veozah, highlighting postmarketing cases of serious hepatotoxicity. Monitoring for liver issues is crucial and involves both lab tests and symptom reporting.
Required Hepatic Laboratory Testing
Your healthcare provider will order blood tests, including serum ALT, AST, ALP, and total and direct bilirubin, to monitor your liver function.
Testing Timeline Before starting Veozah, a baseline liver blood test is required. Treatment should not begin if certain liver enzyme levels are elevated. Follow-up tests are needed monthly for the first three months, then at month 6 and month 9. Additional tests are needed if symptoms of liver problems appear.
Discontinuation Criteria Veozah should be stopped immediately if transaminase levels exceed 5 times the upper limit of normal (ULN) or are more than 3 times ULN with total bilirubin above 2 times ULN. If transaminase levels are greater than 3 times ULN, more frequent testing is required.
Recognizing and Reporting Symptoms of Liver Injury
Patients should be vigilant for and report symptoms of liver injury promptly. Key symptoms include unusual fatigue, nausea, vomiting, decreased appetite, persistent itching, jaundice, dark urine, pale stools, or pain in the upper right abdomen.
Monitoring Other Aspects of Veozah Treatment
Other health factors beyond liver function also require attention during Veozah treatment.
Medication Interactions
Veozah is metabolized by the CYP1A2 enzyme. Taking it with moderate-to-strong CYP1A2 inhibitors can increase fezolinetant levels and side effect risks, and is contraindicated. Always provide a full list of medications and supplements to your doctor.
Renal Function
Veozah is eliminated through the kidneys. Severe renal impairment or end-stage renal disease is a contraindication. Kidney function should be assessed before starting treatment.
Comparison of Monitoring Types
Effective monitoring of Veozah therapy requires collaboration between the patient and healthcare team. The table below outlines their respective roles.
| Monitoring Type | Responsibility | Frequency | Purpose | Action if Concern Arises |
|---|---|---|---|---|
| Hepatic Lab Testing | Healthcare Provider | Baseline, monthly for 3 months, then at 6 and 9 months, and symptom-based | To detect liver injury early, even before symptoms appear | Provider adjusts treatment, potentially discontinuing Veozah |
| Symptom Surveillance | Patient | Daily | To catch subjective and early indicators of liver problems | Patient contacts provider immediately; potential urgent care visit |
| Medication Review | Provider and Patient | Baseline and with any new medication/supplement | To identify and avoid drug-drug interactions that affect Veozah levels | Provider may suggest alternative medication |
| General Health & Side Effects | Patient | Ongoing | To manage common side effects like abdominal pain, diarrhea, and insomnia | Patient discusses management strategies with provider |
Conclusion
Monitoring is a vital component of safe Veozah therapy, primarily focused on liver health. Providers are responsible for scheduled lab tests and screening for contraindications. Patients must actively monitor for and report concerning symptoms. For more detailed information, consult the official FDA-approved patient labeling.
