Effexor effective for hot flashes in patients with breast cancer

Just FYI. The study below was published in OcologyStat, Nov 8, 2010. Not a huge study, but effexor might be an option for those with the hot flashes issue.

Also, FYI, Venlafaxine=Effexor and Gabapentin=Neurontin

"Based on patient preference data, venlafaxine is a preferred and efficacious drug in the treatment of hot flashes in survivors of breast cancer and can be considered a first-line agent over gabapentin.

STUDY IN CONTEXT
Hot flashes are a common problem in breast cancer survivors. Although hormones are effective in the treatment of hot flashes, their safety has not been established in patients with breast cancer. Previous randomized trials have shown that gabapentin and combination selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) agents such as venlafaxine are effective in reducing hot flashes. Although the effectiveness of gabapentin and antidepressants appears to be similar, to date, there is limited data that directly compare these nonhormonal treatments.

This study is an open-label, cross-over, randomized clinical trial, which allowed patients to be their own controls to collect patient preference data, the primary endpoint of the study. A total of 66 women with a history of invasive breast cancer, ductal or lobular carcinoma in situ, without evidence of metastasis, entered the study. Patients had a history of at least 1 month of bothersome hot flashes (≥ 14/week) severe enough that they desired pharmacologic intervention. Menopausal status was not an exclusion criterion. However, patients were excluded if they had received chemotherapy within 8 weeks or planned to have chemotherapy during the 14-week study. Concomitant treatment with tamoxifen, luteinizing hormone–releasing hormone (LHRH) analogs, and aromatase inhibitors was allowed, provided that the patients had been on therapy for at least 4 weeks and would remain on therapy for the duration of the study. Patients were also excluded if they had used venlafaxine or any other antidepressant, including St. John’s wort, within the previous year, used gabapentin or calcium channel antagonists within 2 weeks, or had used any other treatment for hot flashes.

Patients were randomized to venlafaxine 37.5 mg for 7 days then 75 mg daily for 21 days or gabapentin 300 mg at bedtime for 3 days, twice daily for 3 days, then three times daily for 22 days. After 4 weeks, patients were tapered off the medication and were then on a washout period of 2 to 4 weeks before crossover to the other study period for 4 weeks.

A total of 58 patients reported preference data, 2 with no preference between drugs. Of the 56 patients, 68% preferred venlafaxine over gabapentin (P = 0.01). Reasons for preference of one drug over another were similar, with reduction in hot flash severity and frequency and fewer adverse events the same between both groups. The overall efficacy of the two treatments was also similar. However, patients who preferred a particular agent experienced greater hot flash reduction on that agent compared to the alternative (venlafaxine-preferring patients had a 41% lower score for hot flashes; gabapentin-preferring patients had a 47% lower score for hot flashes). Venlafaxine was associated with greater nausea, appetite loss, and constipation but with fewer mood changes and reduced nervousness compared with gabapentin. Gabapentin was associated with more dizziness and increased appetite compared with venlafaxine.

Based on these results, both treatment options are found to be efficacious in treatment of hot flashes in survivors of breast cancer; however, a significant proportion of women preferred venlafaxine over gabapentin. Gabapentin remains an effective and appropriate second-line agent in this patient population."


Venlafaxine vs Gabapentin for the Management of Hot Flashes