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Two new medications to treat hot flashes

Lankenau Medical Center January 22, 2014 By Beverly Vaughn, MD

Hot flashes occur in 80 percent of menopausal women. As many of you know, they can be uncomfortable and disruptive, effecting quality of life. Two new medications are now available to add to currently used treatment options. One is an SSRI (selective serotonin reuptake inhibitor); the other is a combination of estrogen with a class of medication known as a TSEC (tissue selective estrogen complex). The first, Brisdelle™, was FDA approved in 2013 and became available in the fall. Brisdelle™ is an SSRI that demonstrated, in studies, reduction of symptoms in healthy menopausal women with moderate to severe hot flashes. Using SSRI’s for hot flashes is not new. Health care providers have used them for women who can’t take estrogen due to medical conditions such as breast cancer or heart disease and in women who prefer not to take estrogen for personal reasons.

SSRI’s are familiar because they are frequently used to treat depression. They work DIFFERENTLY to treat hot flashes. The SSRI’s act on the center for temperature control in the brain making it less sensitive to changes in the core body temperature. Paxil™ is effective and has been commonly used. Brisdelle™ and Paxil™ are almost identical but the dose of Brisdelle™ is smaller. Women tolerated Brisdelle™ well and had few side effects. This makes it a very good addition to selection of drugs available.

The second medication is an estrogen in combination with a TSEC (tissue selective estrogen complex). This sounds cumbersome but, simply put the TSEC is a medication that in some tissue acts like an estrogen and in others acts as an anti-estrogen. Examples of TSEC’s that may be familiar to you are Evista™ and Tamoxifen™. The new combination medication is called Duavee™ and contains estrogen and bazedoxifene. It will be available sometime in early 2014.The bazedoxifene replaces the progestogen (synthetic or natural progesterone) that needs to be taken by women on estrogen who have their uterus. In studies Duavee™ reduced hot flashes and had a positive effect on bone density. Why come up with a different combination? For one, there are women who have a difficult time tolerating synthetic progestins. It has also been postulated that the synthetics may play a role in the development of breast cancer. Though this has not been established with certainty. Duavee™ was studied in the short term for symptom relief. It has not been studied long enough to make any determination about breast cancer or heart disease risk. With that in mind it will be an option that is effective for symptom relief and maintenance of bone health and should be prescribed within the same guidelines as traditional hormone therapy.

For additional information about these therapeutic choices, always speak with your health care provider.

This article is part of Menopause and You, a web-based program sponsored by Women’s Health Source. It is intended as an information resource providing guidelines for women. As always, check with your own health care provider with your specific concerns and questions.

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