Although estrogen is highly effective for the treatment of hot flushes, many women are reluctant to use hormone therapy to manage these symptoms, given recent concerns that estrogen may carry certain risks.  Several studies have demonstrated that gabapentin (Neurontin) and certain antidepressants, including paroxetine (Paxil) and venlafaxine (Effexor), may be useful non-hormonal treatments for the management of hot flashes.  Data presented at the annual meeting of the American Society of Clinical Oncology indicate that pregabalin (Lyrica), an anticonvulsant drug similar to gabapentin, may also be helpful for alleviating hot flashes.

This study included 207 women who reported at least 28 hot flashes per week.  The study population was a general sample of women, including 40% who had been treated for breast cancer. About 20% of the women were premenopausal.  The participants were randomized to receive pregabalin up to 75 mg twice a day, 150 mg twice a day, or placebo.  Hot flash frequency and severity were monitored using a daily diary.

At 6 weeks of treatment, researchers found that pregabalin was more effective than placebo in reducing both the frequency and severity of hot flashes.  Median hot flash scores decreased by 50% in the placebo group, by 60% in the pregabalin 75-mg group, and by 65% in the 150-mg group.  These differences were statistically significant.  The higher dose of pregabalin was no more effective than the lower dose but was associated with more side effects, including sleepiness, changes in coordination, concentration difficulties, and visual changes.

This preliminary study suggests that pregabalin may be another alternative for the treatment of hot flashes.  The magnitude of response is similar to what has been observed in earlier studies evaluating the effectiveness of gabapentin and several different antidepressants.  (In all of these studies, placebo responses have been high, usually around 50%.)  Overall the medication was well-tolerated, and the authors recommended using 75 mg twice daily to minimize the risk of side effects.

Ruta Nonacs, MD PhD

Loprinzi, C, L. (2009). Pregabalin for hot flashes in women: NCCTG trial N07C1. J Clin Oncol , 27(15).