Women with a history of breast cancer appear to prefer the antidepressant Effexor® (venlafaxine) over the antiseizure drug Neurontin® (gabapentin) for treatment of hot flashes. These findings were recently released in the Journal of Clinical Oncology.

Hot flashes can be a significant problem in women with a history of breast cancer. Given concerns regarding the use of hormonal therapies in such patients, non-hormonal approaches to treating hot flashes are generally used. Antidepressants in addition to Effexor—such as Paxil® (paroxeine hci), Prozac® (fluoxetine), and Zoloft® (sertraline)—have been used to treat hot flashes among breast cancer survivors. The antiseizure medication Neurontin may also be used as a non-hormonal therapy for hot flashes.

Though Effexor and Neurontin may both reduce hot flashes, researchers have yet to determine which medication breast cancer survivors prefer. To establish a preference, researchers evaluated both drugs among postmenopausal women. Participants had experienced at least 14 significant hot flashes per week before the study began. Women were treated with either four weeks of Effexor followed by four weeks of Neurontin, or four weeks of Neurontin followed by four weeks of Effexor.

Participants used diaries to report hot flashes and side effects of Effexor and Neurontin. At the end of the trial, 56 women reported their preferences and the types of side effects they experienced.

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  • Sixty-eight percent (38) of participants preferred Effexor, while about half as many (32%, or 18) preferred Neurontin.
  • Both Effexor and Neurontin reduced hot flashes by 66%.
  • Side effects differed between the two agents: Effexor was associated with increased nausea, appetite loss, and constipation compared with Neurontin, whereas Neurontin was associated with increased dizziness and appetite compared with Effexor.
  • Patients reported fewer negative mood changes with Effexor than with Neurontin.

The researchers concluded that breast cancer patients prefer Effexor over Neurontin for treatment of hot flashes. Both agents, however, appear effective and are well tolerated. It should be noted that neither drug has been FDA approved for the management of hot flashes.

Reference: Bordeleau L, Pritchard KI,  Loprinzi CL, et al. Multicenter, randomized, cross-over clinical trial of venlafaxine versus gabapentin for the management of hot flashes in breast cancer survivors. Journal of Clinical Oncology [early online publication]. November 8, 2010.

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