Nonhormonal hope for vasomotor symptoms?

Desvenlafaxine succinate, a serotonin norepinephrine reuptake inhibitor (SNRI), reduces hot flashes by about 64% after 3 months of use, according to the results of a double-blind, placebo-controlled trial.

Researchers randomized 707 healthy postmenopausal women experiencing 50 or more moderate-to-severe hot flushes per week to either desvenlafaxine 50, 100, 150, or 200 mg or placebo daily for 52 weeks.

Desvenlafaxine 100 mg/d significantly reduced the average daily number of hot flushes compared with placebo at weeks 4 (P=.013) and 12 (P=.005). In addition, compared with placebo, 12 weeks of 100 mg/d of the drug significantly reduced the severity of hot flushes and was associated with a significantly higher 75% responder rate (50% for desvenlafaxine vs. 29% for placebo). Efficacy, as measured by a 50% reduction from baseline in number of hot flushes, was reached within 1 week of treatment, compared with 3 to 4 weeks for placebo. And desvenlafaxine significantly reduced nighttime awakenings due to hot flushes.

Speroff L, Gass M, Constantine G, et al. Efficacy and tolerability of desvenlafaxine succinate treatment for menopausal vasomotor symptoms: a randomized controlled trial. Obstet Gynecol. 2008;111: 77–87.