Veozah vs Gabapentin for Hot Flashes: Which Should You Ask About?

Best for / not for you

Veozah vs gabapentin at a glance

The full comparison: Veozah vs gabapentin, side by side

Most pages describe each drug on its own and leave you to do the math. We built the table we wish existed — every row is a real decision, and every fact is sourced and dated below.

Last verified: July 2026. Sources listed at the end of the page.

Sources: FDA approval and prescribing information; The Lancet (SKYLIGHT 1) and JCEM (SKYLIGHT 2); The Menopause Society 2023 Nonhormone Therapy Position Statement; FDA Drug Safety Communications (Veozah liver, Dec 2024; gabapentinoid breathing risk, Dec 2019); GoodRx and SingleCare pricing (July 2026); Astellas VEOZAH Savings Program terms.

Which works better for hot flashes — Veozah or gabapentin?

What the Veozah trials showed

Veozah’s approval rests on the SKYLIGHT trials— two large studies where women started with at least 7 moderate-to-severe hot flashes a day. On the 45 mg dose:

• ›By week 12, hot flashes dropped by about 2.5 more per day than placebo (2.55 fewer per day in SKYLIGHT 1; 2.53 in SKYLIGHT 2). That gap is statistically solid.
• ›From where women started, that’s roughly a 60% drop in how often hot flashes hit.
• ›Relief showed up as early as week 1 and held for a year.

Why does the “2.5 more than placebo” number matter? In hot-flash studies, placebo alone helps a lot — the fair test is how much more the drug does than a sugar pill. Veozah clears that bar.

What gabapentin’s studies showed

Gabapentin isn’t FDA-approved for hot flashes, but it has real evidence behind it. In randomized trials, 900 mg a day cut hot flashes by roughly 35–50%. One well-known study found a 45% drop in how often they hit and about a 54% drop in a combined score of frequency and severity. Higher doses can do a little more, but the trade is more drowsiness and dizziness.

The honest read on “better”

For scale: if maximum relief is all you care about and you’re a candidate, hormone therapy is still the most effective treatment for hot flashes — a conversation worth having.

Is Veozah’s liver warning a dealbreaker?

The monitoring schedule, plain and simple

Who shouldn’t take Veozah

Veozah is off the table if you have known cirrhosis, severe kidney disease or end-stage renal disease, or you take a “CYP1A2 inhibitor” — a type of drug (including some antidepressants and the antibiotic ciprofloxacin) that blocks how your body clears Veozah. Your clinician checks this against your medication list.

Honest context:in the trials, serious liver issues were rare, mostly showed no symptoms, and reversed when the drug stopped. The warning is serious enough to respect and monitor — notserious enough that it automatically rules Veozah out for a woman with healthy liver labs who wants it. That’s a call to make with a clinician who runs the tests.

Gabapentin’s safety picture

Gabapentin’s main concern is the opposite kind: it can make you drowsy, dizzy, or unsteady, especially at first. There’s also an FDA warning from 2019 that gabapentin can cause serious breathing problems when combined with opioids or other sedatives, or in people with COPD or older age. For an otherwise-healthy woman not on those medicines, that risk is much lower — but it’s why your full medication list matters.

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Which costs more — Veozah or gabapentin?

• ›Veozah’s price swings by pharmacy — sometimes $100+ between two stores in the same town, so it pays to compare on GoodRx or SingleCare before you fill.
• ›The savings card is the game-changer, but only with commercial insurance. If you have Medicare or Medicaid, you can’t use it — and Veozah can get expensive fast. Astellas also runs a patient-assistance program for uninsured, qualifying patients.
• ›Gabapentin is cheap even without insurance. For a typical hot-flash dose (about 900 mg a day), a free coupon usually lands it under about $11 a month. If your insurance copay is higher than the coupon, just use the coupon.

Which is better for night sweats and sleep?

Night sweats are a different job than daytime flashes. You’re not asking “which drug has the best label?” You’re asking, “which one lets me sleep without feeling useless in the morning?”

That’s where gabapentin’s biggest downside becomes an upside. Taken at bedtime, the same drowsiness that’s annoying during the day can help you fall — and stay — asleep while it dials down the sweats. The Menopause Society specifically notes gabapentin is most useful when symptoms are worst at night.

Quick way to sort it: if night sweats and broken sleep are your whole problem, gabapentin is worth asking about first. If you’re flashing all day and can’t afford grogginess, lean Veozah. And if insomnia is already severe on its own, tell your clinician before you start either — it changes the plan.

The one catch nobody tells you: neither drug is a full menopause plan

That’s not a flaw if hot flashes or night sweats are your whole problem— they’re excellent at that one job. But if you’re also dealing with vaginal dryness, painful sex, urinary changes, mood swings, brain fog, low libido, or bone worries, then picking “Veozah or gabapentin” is answering the wrong question. You’d fix the flashes and still feel awful.

Who is Veozah usually the better fit for?

You’re probably a good fit to ask about Veozah if:

• ✓Hot flashes or night sweats are your main symptom (not a broad mix).
• ✓You want an FDA-approved non-hormonal option — approval means it was tested and cleared for exactly this use.
• ✓You can’t take or don’t want hormones — for example, a history of certain cancers, blood clots, or personal preference.
• ✓You need to stay sharp during the day and don’t want a sedating medicine.
• ✓You have commercial insurance (the savings card makes the price realistic) or can cover the cost.
• ✓Your liver is healthy and you can keep up with the blood tests.

You’re probably notthe right fit — and gabapentin or another route may serve you better — if cost is a hard limit, you have liver disease, severe kidney disease, or you take a drug that clashes with Veozah.

Who is gabapentin usually the better fit for?

You’re probably a good fit to ask about gabapentin if:

• ✓Your worst symptoms hit at night and wreck your sleep.
• ✓Cost matters more than having a newer brand-name drug.
• ✓You can handle some drowsiness — often an upside at bedtime.
• ✓You already have a nerve-pain reason your clinician knows about.
• ✓You understand it’s off-label for hot flashes, and you’re comfortable asking why it’s the pick.

Can gabapentin cause swelling, weight gain, or mood changes?

Here are the specifics from gabapentin’s own labeling (measured in its nerve-pain trials):

• ›Dizziness: about 21–28% of people, versus 5–8% on placebo.
• ›Drowsiness: about 16–21%, versus 5% on placebo.
• ›Swelling in the limbs (peripheral edema): about 8%, versus 2% on placebo. Some people also see modest weight gain.

Most of the dizziness and drowsiness tends to ease within the first few weeks as your body adjusts, though that varies by person and dose. The swelling is usually mild but worth flagging if it shows up.

On mood: gabapentin belongs to the anticonvulsant family, and that whole class carries an FDA warning about a small increase in suicidal thoughts or behavior. It’s not specific to menopause, and it’s not common — but if you or someone close to you notices new depression, anxiety, or dark thoughts after starting it, that’s a call-your-doctor-now situation, not a wait-and-see one.

Can you take Veozah and gabapentin together?

How do Veozah and gabapentin compare to HRT, Lynkuet, Brisdelle, and other options?

Veozah and gabapentin are two non-hormonal choices, but they aren’t the whole menu. Other options include hormone therapy for eligible women, a newer non-hormonal drug called Lynkuet, low-dose paroxetine (Brisdelle), other antidepressants used off-label, and oxybutynin. If neither of our two headliners feels right, you still have paths.

The takeaway: “Veozah vs gabapentin” isn’t the whole decision. If you’re a candidate for hormones and open to them, HRT is the most effective route. If you want non-hormonal, there are now several options. See our full non-hormonal options comparison.

What to ask your clinician before you choose

Where to get evaluated for non-hormonal options

The HRT Index may earn a commission if you use some provider links. It doesn’t change our verification or our recommendations.

Some readers discover partway through that they’re a candidate for hormone therapy and would prefer it — HRT is the most effective option for hot flashes. If that’s you, don’t force a non-hormonal fit. explore your HRT provider options via Find My HRT Path instead.

What real women say

We don’t use reviews to prove a drug works or is safe — that’s what the trials and the FDA are for. These are individual experiences, shared publicly, to show what the day-to-day can feel like. Your results may differ.

Notice what those two quotes capture together: gabapentin’s night-sweat-and-sleep sweet spot, and Veozah’s effectiveness alongside its very real insurance hassle. That’s the whole trade-off in two sentences.

What we actually verified

Frequently asked questions

Is Veozah better than gabapentin for hot flashes?

Veozah is the only one of the two that’s FDA-approved specifically for hot flashes, and it worked well in large trials. Gabapentin also reduces hot flashes, especially night sweats and related sleep loss, but it’s off-label for menopause. No study has compared the two head-to-head, so no one can honestly say one beats the other; the better pick depends on your cost, sleep, safety, and situation.

Is gabapentin FDA-approved for menopause hot flashes?

No. Gabapentin is FDA-approved for shingles nerve pain and certain seizures. For hot flashes it’s used off-label, which is legal, common, and evidence-backed, but it was never formally approved for menopause. Off-label is not the same as unproven or compounded.

Is Veozah a hormone?

No. Veozah (fezolinetant) is a non-hormonal prescription pill. It works by blocking a brain signal (the NK3 receptor) that drives hot flashes when estrogen drops, rather than by replacing estrogen.

Which is cheaper, Veozah or gabapentin?

Gabapentin, by a wide margin. It’s a generic that usually costs about $9–$11 a month with a free coupon. Veozah runs about $690–$772 a month at full retail, roughly $474–$485 with a discount card, and has no generic. With commercial insurance, Veozah’s savings card can lower it to $0 the first month and about $30 per refill.

Do you need liver tests with Veozah?

Yes. You get a liver blood test before starting, then monthly for the first 3 months, and again at 6 and 9 months. You shouldn’t start Veozah if your liver enzymes (ALT or AST) or bilirubin are at least twice the top of the normal range, and you should stop and call your doctor if you notice signs of a liver problem like yellow skin, dark urine, or belly pain.

Does gabapentin help with sleep?

It can, when night sweats and poor sleep go together. A bedtime dose may calm the sweats and its drowsiness doubles as a sleep aid. The trade-off is possible next-day grogginess or dizziness, so discuss both the benefit and the side effects with your clinician.

Can gabapentin cause swelling or weight gain?

It can in a minority of people. Gabapentin’s labeling lists swelling in the limbs (about 8% of people, versus 2% on placebo) and some weight gain. It’s usually mild, but worth mentioning to your clinician if it appears.

Who should not take Veozah?

Women with known cirrhosis, severe kidney disease or end-stage renal disease, or who take a CYP1A2 inhibitor (a drug that blocks how the body clears Veozah). Anyone whose liver enzymes are already high shouldn’t start it. A clinician reviews your liver, kidneys, and full medication list first.

Who should be careful with gabapentin?

People who take opioids or other sedatives, drink alcohol regularly, have COPD or another lung condition, have kidney problems, are older, or need to drive and stay alert. The FDA warns of serious breathing problems with gabapentin in those higher-risk situations.

Is gabapentin a controlled substance?

Not federally. But a handful of states — including Alabama, Kentucky, North Dakota, Tennessee, Utah, Virginia, and West Virginia — classify it as a Schedule V controlled substance (Michigan did, then reversed in 2024). In those states, prescribing and refills are tighter, and getting it through telehealth can be harder. Check your state.

Can either medication treat vaginal dryness or painful sex?

No. Veozah and gabapentin treat hot flashes and night sweats only. Vaginal dryness, painful sex, and urinary symptoms need different treatment, often local vaginal estrogen or other options. If those are part of your picture, you need a broader plan.

What if I have a history of breast cancer?

Don’t choose based on a general article. Talk to your oncologist or a menopause clinician experienced with cancer survivors, especially if you take tamoxifen, an aromatase inhibitor, or ovarian suppression, since those affect which options are safe.

Is Lynkuet an alternative to Veozah?

Yes. Lynkuet (elinzanetant) is a newer FDA-approved non-hormonal option for moderate-to-severe hot flashes, approved in 2025, taken as 120 mg once daily at bedtime. It’s not the same drug as Veozah — it blocks two brain signals (NK1 and NK3) instead of one and may help sleep. It has its own safety profile, including liver-lab monitoring, a pregnancy contraindication, a daytime-drowsiness warning, and a grapefruit/interaction caution.

Can online providers prescribe Veozah or gabapentin?

Some online menopause providers can evaluate non-hormonal options and prescribe. Whether they can prescribe Veozah or gabapentin depends on the provider, the clinician, your state, controlled-substance rules for gabapentin, your labs, your medication list, and whether online care is appropriate for you. Don’t pick a provider just because you want one specific drug.

Sources

This page is independent editorial research from The HRT Index. It is not medical advice and not a substitute for care from a licensed clinician. It has not been medically reviewed by a clinician. We may earn a commission if you start care through some links on this page, at no extra cost to you; it never changes what we verify or recommend. Last verified: July 2026.