- Question from guest1: Why do hot flashes occur and can you take anything for them?
Hot flashes are common with breast cancer therapy. They come from women going through menopause related to chemotherapy, or they might be related to hormone treatment they are receiving, like tamoxifen or aromatase inhibitors. They can be quite problematic, as they can be for women who get hot flashes unrelated to breast cancer. With breast cancer, the hot flashes are oftentimes more substantial than for other women, because the menopause may come on more abruptly. We generally avoid hormones in patients with breast cancer. Over the last decade, information has become available that non-hormonal drugs can decrease hot flashes moderately. The first class of medications that have been helpful are some of the newer antidepressants in low to moderate doses. The best-studied ones are venlafaxine (brand name: Effexor), and paroxetine (brand name: Paxil). The latter one should not be used with tamoxifen, however. Newer information suggests that Celexa (chemical name: citalopram) may also be helpful. Lastly, two other classes of drugs also seem to decrease hot flashes moderately. Those include an anti-seizure medication, gabapentin (brand name: Neurontin) and an older blood-pressure medication called clonidine (brand name: Catapres).
Editor's Note: If you are taking tamoxifen, it's important to know that certain antidepressants can interfere with the body’s ability to convert tamoxifen into its active form. These include Paxil (chemical name: paroxetine), Prozac (chemical name: fluoxetine), Zoloft (chemical name: sertraline), and others. Please visit the Tamoxifen section for more information.
- Mindy Goldman, M.D. For some breast cancer patients, some of the medicines may be able to help out in many ways. For some women who have had mastectomies, they may have chest wall pain that may be helped by neuropathic pain relievers such as gabapentin. It's important for your physicians to visualize therapy and important for them to know about some of the alternatives that may be helpful for menopausal symptoms like hot flashes. There are also non-prescription meds like black cohosh that may be helpful for some women, but in general, most of these haven't been studied well enough for us to tell women about their effectiveness and safety. Finally, if the hot flashes really are unbearable, it's important to talk to your breast cancer physicians about the treatments you are on to determine whether a change in treatment might be an option.
On Wednesday, August 20, 2008, our Ask-the-Expert Online Conference was called Managing Menopausal Symptoms. Charles Loprinzi, M.D. and Mindy Goldman, M.D. answered your questions about how you can manage menopausal symptoms such as hot flashes, vaginal dryness, insomnia, and more.
The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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