Fezolinetant for Treating Hot Flashes in Menopausal Women

Advantages Over Traditional Treatments

The American Society of Clinical Oncology notes that fezolinetant avoids the 10-20% treatment withdrawal rate seen with SSRIs/SNRIs due to adverse events, and doesn't require gradual discontinuation to prevent withdrawal symptoms, with a more targeted mechanism of action specific to hot flash pathophysiology 1
The American Society of Clinical Oncology also notes that fezolinetant doesn't have potential drug interactions with tamoxifen through CYP2D6 inhibition, making it a suitable option for breast cancer survivors on tamoxifen 2

The National Comprehensive Cancer Network may consider fezolinetant particularly for women who experienced inadequate response or intolerable side effects with SSRIs/SNRIs, with significant improvements seen by week 4 1
The American College of Obstetricians and Gynecologists may consider fezolinetant for women with contraindications to hormone therapy, and for breast cancer survivors on tamoxifen where some SSRIs/SNRIs may interfere with tamoxifen metabolism 2

The National Comprehensive Cancer Network recommends fezolinetant as a first-line non-hormonal treatment option for women seeking non-hormonal therapy or with contraindications to hormone therapy, and menopausal hormone therapy remains most effective for vasomotor symptoms but carries risks including increased stroke and breast cancer risk 3, 4

The National Comprehensive Cancer Network suggests SNRIs/SSRIs, gabapentin or pregabalin, and clonidine as alternative options if fezolinetant is unavailable or contraindicated, with considerations for potential interactions and side effects 3

The National Comprehensive Cancer Network recommends cognitive behavioral therapy, weight loss if overweight, smoking cessation, and acupuncture as non-pharmacologic adjuncts to reduce hot flash symptoms, with evidence showing their effectiveness in reducing perceived burden of hot flashes and improving frequency and severity of hot flashes 4, 5