Most prescribable alternative therapies have been evaluated for their impact on vaso-motor symptoms. Some of them also have an impact on mood and well-being. The class effect of the drug is important in selecting what is likely to be the best alternative for your patient. Menopause treatments also tend to have a high placebo response often as great as 50% which may enhance quoted “baseline effectiveness”.
| Added benefit | Dose | Added Benefit | Adverse Effect | |
| Gabapentin | 50% | Gamma amino-butyric acid analogue used to treat epilepsy, neurogenic pain and migraine; reduces hot flushes at a dose of 900mg per day |
Improved quality of sleep |
Dry mouth dizziness and drowsiness with a very specific dose related component |
| Pregabalin | 50% | 50-300mg in divided doses |
Improved quality of life |
Similar to Gabapentin but less marked and therefore better tolerated More expensive |
| Clonidine | no information available |
25-50 mcg bd up to a maximum of 75 micrograms bd or 50mcg tds | May complement other antihypertensive drugs Only licensed option |
Interaction with anti-hypertensive drugs and not suitable for patients with baseline low blood pressure Must be reduced gradually otherwise causes rebound hypertension Dose related side-effects include sleep disturbance in at least 50% of patients, dry mouth nausea and fatigue. |
| SSRI | 20-50% | Class effect of SSRIs are of antidepressant benefit and improved quality of life. | Class effect of SSRIs include initial side effects such as nausea, dizziness, shortterm aggravation of base-line anxiety and mood, so encourage your patient to persevere and if necessary take on alternative days, even ½ tablet Class effect of all SSRIs is sexual dysfunction No one SSRI is better than any other in this respect and there is great individual variation in response. |
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| Paroxetine | 50-60% | Dosage 10-20mg – Paroxetine has best evidence for vaso-motor control and has maximal benefit achieved at 10mg. | Class effect of SSRIs are of antidepressant benefit and improved quality of life. | Interacts with enzyme cytochrome P450 (CYN10) thereby rendering Tamoxifen less effective. |
| Fluoxetine | 10-20% | 20mg | Class effect of SSRIs are of antidepressant benefit and improved quality of life. | Like Paroxetine should be avoided in patients taking Tamoxifen. |
| Citalopram (escitalopram) | 40-50%. | 20mg | Class effect of SSRIs are of antidepressant benefit and improved quality of life. | Much less effect on enzyme cytochrome P450 so can be used in patients on Tamoxifen. |
| Sertraline |
no information available |
25-50mg | Sertraline is the best anti-anxiety SSRI | The least well tolerated with an increase in anxiety at the outset. Interacts with cytochrome P450, so avoid in patients on Tamoxifen |
| Venlafaxine | 20-66% | 37.5mg – 150mg sustained release preparations recommended | Improved quality of life Antidepressant effect | > Often poorly tolerated at outset with dizziness and other associated SSRI side effects including sexual dysfunction, slow titration may be the answer > NO interaction with cytochrome P450 so may be safest choice for patients on Tamoxifen. |
British Menopause Society
