Understanding Veozah and the Need for Alternatives
Veozah (fezolinetant) is a non-hormonal prescription medication approved by the FDA in May 2023 to treat moderate to severe vasomotor symptoms (VMS), commonly known as hot flashes and night sweats, due to menopause [1.2.3, 1.2.5]. It works by blocking the neurokinin 3 (NK3) receptor in the brain's temperature-regulating center, the hypothalamus [1.2.4]. This action helps restore a balance that is disrupted by declining estrogen levels, thereby reducing the frequency and severity of hot flashes [1.2.1].
While Veozah represents a novel approach, it may not be suitable for everyone. Reasons for seeking an alternative can include cost, potential side effects, or specific health conditions. The FDA has issued a warning that Veozah can cause liver injury, and regular liver function tests are required before and during treatment [1.2.1]. It is contraindicated for individuals with cirrhosis, severe kidney problems, or those taking CYP1A2 inhibitor medications [1.2.4]. Given these factors, many women and their healthcare providers explore other available treatments.
Hormonal Alternatives: The Gold Standard
Hormone replacement therapy (HRT) has long been considered the most effective treatment for menopausal VMS [1.5.1]. It works by replenishing the body's estrogen levels, which directly addresses the root cause of many menopausal symptoms [1.5.1].
- Estrogen Therapy: For women who have had a hysterectomy (uterus removed), estrogen can be prescribed alone [1.5.3]. It is available in various forms, including pills, patches, gels, and creams [1.5.1]. Transdermal (patch) estrogen is often preferred as it may not carry the same risk of blood clots associated with oral estrogen [1.5.2].
- Combined Estrogen and Progestin Therapy: Women who still have a uterus must take a progestogen (like progesterone) along with estrogen [1.5.3]. This is crucial because taking estrogen alone increases the risk of endometrial cancer (cancer of the uterine lining); progestin protects the uterus from this risk [1.5.2].
HRT is highly effective but is not recommended for everyone. Contraindications include a history of breast cancer, stroke, heart attack, or blood clots [1.5.6]. The decision to use HRT is highly individualized and should be made with a healthcare provider after weighing the benefits and risks, especially for women under 60 or within 10 years of menopause onset [1.5.1].
Non-Hormonal Prescription Alternatives
For women who cannot or prefer not to take hormones, several other FDA-approved and off-label prescription medications are effective alternatives.
- SSRIs/SNRIs (Antidepressants): Certain antidepressants are commonly used to manage VMS.
- Paroxetine (Brisdelle): This is the only antidepressant specifically FDA-approved in a low-dose form (7.5 mg) to treat moderate to severe hot flashes [1.7.1, 1.4.4]. It is a selective serotonin reuptake inhibitor (SSRI) [1.7.3]. Higher doses of paroxetine are used for psychiatric conditions, but Brisdelle is not indicated for such uses [1.7.3].
- Venlafaxine and Desvenlafaxine: These are Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) used off-label for VMS. They can reduce the frequency and severity of hot flashes [1.3.2, 1.4.2].
- Gabapentin (Neurontin): Originally an anti-seizure medication, gabapentin has been shown to be effective in reducing hot flashes, especially night sweats [1.8.1, 1.8.3]. It can be particularly helpful for women whose symptoms disrupt their sleep, though side effects like dizziness and drowsiness are common [1.8.4].
- Oxybutynin: This medication is approved for treating overactive bladder but is used off-label for VMS [1.5.3]. Studies have shown it can significantly reduce the frequency and severity of hot flashes [1.9.4, 1.9.5]. Common side effects include dry mouth and constipation [1.9.3].
- Clonidine: A blood pressure medication, clonidine can provide some relief from hot flashes but is generally considered less effective than other options and can have side effects like dizziness and dry mouth [1.4.4].
Comparison of Veozah Alternatives
| Treatment Option | Mechanism of Action | Primary Use | Common Side Effects | Considerations |
|---|---|---|---|---|
| Hormone Therapy (HRT) | Replaces estrogen [1.5.1] | Menopause VMS, osteoporosis prevention [1.5.5] | Breast tenderness, headache; risks include blood clots, stroke [1.5.2, 1.5.6] | Most effective option; not suitable for women with certain cancer or cardiovascular risks [1.5.6]. |
| Paroxetine (Brisdelle) | SSRI; mechanism for VMS unknown [1.7.3] | Moderate to severe VMS [1.7.1] | Nausea, drowsiness, decreased libido [1.4.2] | FDA-approved non-hormonal option; a low dose specifically for hot flashes [1.7.1]. |
| Gabapentin (Neurontin) | Anti-convulsant; slows brain activity [1.8.4] | Seizures, nerve pain; off-label for VMS [1.8.4] | Drowsiness, dizziness, weight gain [1.8.3] | Can be particularly helpful for night sweats and sleep disturbances [1.8.4]. |
| Oxybutynin | Anticholinergic [1.9.3] | Overactive bladder; off-label for VMS [1.9.1] | Dry mouth, constipation, drowsiness [1.9.3] | May benefit women experiencing both VMS and bladder symptoms [1.4.2]. |
Lifestyle Modifications and Complementary Therapies
While not direct medication substitutes, several lifestyle changes and therapies can significantly help manage hot flashes:
- Dietary Changes: Avoiding triggers like spicy foods, caffeine, and alcohol can reduce the frequency of hot flashes [1.6.1]. Some research suggests that diets rich in whole soy foods may help [1.6.4].
- Staying Cool: Dressing in layers, using fans, and keeping the bedroom cool at night are simple yet effective strategies [1.6.2].
- Mind-Body Practices: Techniques such as cognitive behavioral therapy (CBT), clinical hypnosis, and mindfulness meditation have been shown to help manage the impact of hot flashes [1.4.2, 1.6.2].
- Exercise: Regular physical activity can help maintain a healthy weight and may reduce the severity of symptoms [1.6.3].
- Supplements: Many herbal remedies like black cohosh and dong quai are marketed for menopause symptoms, but clinical evidence for their efficacy and safety is often weak or inconsistent [1.4.1, 1.6.2]. Always consult a healthcare provider before starting any supplement.
Conclusion
For women seeking an alternative to Veozah, a range of effective options is available. Hormone replacement therapy remains the most potent treatment for vasomotor symptoms for eligible candidates [1.5.1]. For those who need or prefer a non-hormonal path, prescription medications like the low-dose SSRI paroxetine (Brisdelle), gabapentin, and oxybutynin offer proven relief [1.4.2]. Additionally, strategic lifestyle and dietary adjustments can provide a strong foundation for managing symptoms [1.6.1]. The best choice depends on an individual's specific health profile, symptom severity, and personal preference, making a thorough discussion with a healthcare professional essential.
