Hot Flash Medications for People With Breast Cancer

Sometimes exercise, changes to diet, and other strategies to ease hot flashes simply don’t work. However, some medications can help provide some relief.

The most effective way to ease hot flashes is to take estrogen. But taking estrogen carries risks, especially if you have a history of or are at high risk for developing breast cancer. If taking estrogen is not right for you, other medicines can treat hot flashes.

In 2023, the U.S. Food and Drug Administration (FDA) approved Veozah (chemical name: fezolinetant), a new drug for the treatment of hot flashes. It’s taken as a daily pill. 

Veozah works by blocking some of the activity of the neurons in the brain that regulate body temperature. When estrogen levels are low, these neurons become overactive, triggering hot flashes. Veozah basically calms these neurons down. Research found that women taking Veozah had less frequent and less severe hot flashes and night sweats — and reported better sleep — than women taking a placebo.

In 2024, the FDA issued a statement that Veozah could cause rare but serious liver injury and a boxed warning to the medicine’s label.

You should stop taking Veozah immediately and contact your doctor if you are experiencing any symptoms of liver problems, including nausea, vomiting, jaundice, pale feces, dark urine, new fatigue, or pain in the upper right abdomen.

If you’re considering taking Veozah, your doctor will now first give you a blood test to assess your liver function before prescribing you the medicine. These tests will be repeated monthly for the first three months you’re taking Veozah, and then again at six and nine months of treatment.

Low-dose antidepressant medication may lessen the frequency and severity of hot flashes by rebalancing or intercepting epinephrine and serotonin, the chemicals in the brain that transmit the hot flash signal. Clinical trials have shown that antidepressants can lead to a 50% to 60% reduction in hot flashes. Examples include:

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  Effexor XR (chemical name: venlafaxine HCI)

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  Lexapro (chemical name: escitalopram)

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  Paxil and Brisdelle (chemical name: paroxetine)

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  Prozac (chemical name: fluoxetine)

If you’re taking tamoxifen, then Paxil, Brisdelle, and Prozac generally aren’t recommended. They can interfere with the body’s ability to convert tamoxifen into its active form and prevent you from getting the full benefit of the medicine.

Medications that lower blood pressure may lower the frequency and severity of hot flashes by changing how the blood vessels respond to the brain’s command to give off heat quickly. These medicines must be adjusted carefully by your doctor, so they are not frequently used just to control hot flashes. However, if you have high blood pressure that requires treatment with these types of medications, controlling hot flashes can be an added benefit. Examples include:

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  Catapres-TTS (chemical name: clonidine)

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  Aldomet (chemical name: methyldopa)

The drug Neurontin (chemical name: gabapentin), known best as an anti-seizure medication as well as a drug that eases nerve pain, has been used in the past to provide relief. Research has found that people taking Neurontin can experience a 50% to 60% reduction in hot flashes after the first four weeks. This medication is generally tolerated very well but can have mild side effects. The most common ones are dizziness, sleepiness, headache, and mild swelling in the hands and feet.

You may have heard of dietary supplements that may help ease hot flashes, including plant estrogens such as soy, black cohosh, ginseng, dong quai, and vitamin E.  Before taking any over-the-counter remedy or dietary supplement that claims to help ease hot flashes, it’s important to talk with your doctor first. Some of these supplements can have serious side effects, like liver damage, and can also interact with certain medicines.

Learn more about natural remedies for hot flashes.