Data table · Reference
Nonhormonal Hot Flash Reference
The nonhormonal medications used for menopausal hot flashes and night sweats — both the three FDA-approved for this use and the agents commonly prescribed off-label. Each row lists the drug class, approval status, how it works, and the monitoring or cautions that most affect its fit.
FDA-approved for hot flashes
Three nonhormonal prescription medicines are FDA-approved specifically to treat moderate-to-severe vasomotor symptoms of menopause.
| Agent | Class | FDA status (VMS) | How it works | Key monitoring / cautions |
|---|---|---|---|---|
| Paroxetine 7.5 mg (Brisdelle) | SSRI (low dose) | FDA-approved for VMS (2013) | Low-dose selective serotonin reuptake inhibitor; the only SSRI approved specifically for hot flashes. | No drug-specific labs. Strong CYP2D6 inhibitor — caution with tamoxifen. |
| Fezolinetant 45 mg (Veozah) | NK3 receptor antagonist | FDA-approved for VMS (2023) | Blocks the neurokinin-3 receptor in a brain pathway that regulates body temperature. | Boxed warning for liver injury (2024). Liver tests before start, monthly ×3, then months 6 and 9. |
| Elinzanetant (Lynkuet) | Dual NK1/NK3 antagonist | FDA-approved for VMS (Oct 2025) | Blocks both NK1 and NK3 receptors in the temperature-control pathway; taken at bedtime. | Baseline liver testing and again at about 3 months; no boxed warning. Contraindicated in pregnancy. |
Commonly used off-label
These medicines are not FDA-approved for hot flashes but are supported by clinical evidence and are widely used off-label, often when an approved option is unsuitable.
| Agent | Class | FDA status (VMS) | How it works | Key monitoring / cautions |
|---|---|---|---|---|
| Venlafaxine | SNRI | Off-label for VMS | Serotonin-norepinephrine reuptake inhibitor; one of the better-studied nonhormonal options for hot flashes. | May raise blood pressure; taper to stop. Does not inhibit CYP2D6, so often preferred with tamoxifen. |
| Escitalopram / citalopram | SSRI | Off-label for VMS | SSRIs shown to reduce hot-flash frequency and severity in trials. | Weaker CYP2D6 effect than paroxetine; standard SSRI precautions. |
| Gabapentin | Anticonvulsant | Off-label for VMS | Reduces hot flashes and can help sleep; sometimes dosed at night. | Drowsiness and dizziness are common; dose is adjusted in kidney impairment. |
| Oxybutynin | Anticholinergic | Off-label for VMS | Reduces hot flashes in trials; also used for overactive bladder. | Anticholinergic side effects (dry mouth, constipation); caution with long-term use in older adults. |
| Clonidine | Alpha-2 agonist | Off-label for VMS | Blood-pressure medicine with modest hot-flash benefit; largely superseded by newer options. | Low blood pressure, dry mouth, drowsiness; do not stop abruptly. |
More in the library
Reference material only — not medical advice, and not a complete list of doses or contraindications. Approval status and safety information change; verify against the current FDA prescribing label. Sources: FDA / DailyMed prescribing labels, the FDA 2024 Veozah safety update, and The Menopause Society. Last updated July 1, 2026.