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Study May Help Cool Hot Flashes for Cancer Patients

Hot flashes can be a very debilitating condition for women who undergo estrogen depletion, either naturally (with menopause), with surgical ablation (of the ovaries), with certain types of chemotherapy, or with pelvic radiation, any of which can induce sterilization.  For many women, hot flashes are a tolerable condition, even though it has great “nuisance value”. For others, the symptoms are much more severe and can be quite debilitating.  Of course, estrogen or progesterone replacement are “natural therapies”, but there are known risks of taking estrogen for a prolonged period of time.  And some women are still symptomatic with estrogen replacement therapy, except in high doses.

A new study has identified yet another drug for hot flashes.  This trial was conducted by Dr. Charles Loprinzi and colleagues from the Mayo Clinic in Rochester, MN (see video) who found that a commonly used neurology drug can significantly reduce the frequency and intensity of hot flashes. A substantial number of these women had a history of breast cancer and many of them were taking various anti-estrogen hormone therapies for their breast cancer.  In this trial, a total of 207 women were enrolled into the trial because they had “bothersome hot flashes,” as defined by occurrence at least 28 times per week and sufficient severity to make the patient desire therapeutic intervention.

Two doses of Lyrica (Pfizer, NY, NY) were administered (75 mg twice a day, or 150 mg twice a day) compared to a placebo (sugar pill). The investigators found that Lyrica decreased hot flashes and was reasonably well tolerated. The lower dose was recommended (75 mg twice daily) and its effects were roughly comparable to those previously reported with other drugs. The higher dose of Lyrica (150 mg twice daily) had significantly more toxicity than the placebo and was primarily associated with symptoms of dizziness, mental confusion and memory disturbances.

Compared to base-line, the frequency of hot flashes was reduced by 58.5% with the lower dose of Lyrica, and 61% with the higher dose.  Interestingly, there was a 36% reduction in the frequency of hot flashes for women were on the placebo! (This emphasizes the need for such control trials when the end points of the trial are symptom relief.)

This is a very nice clinical trial with a convincing result that adds another tolerable and safe drug to the list of those that physicians can use for treating severe hot flashes. There have been a number of other drugs that provide a 50% or greater reduction in hot flash frequency or severity. A partial list of those prescription drugs approved for use in treating hot flashes include:

  1. Gabapentin (Gabarone, Pfizer, NY, NY)
  2. Venlafaxine (Effexor, Wyeth Laboratories, Pfizer, NY, NY)
  3. Desvenlafaxine (Pristiq, Wyeth Laboratories, Pfizer, NY, NY)
  4. Fluxotine (Prozac, Lilly, Indianapolis, Indiana)
  5. Citalopram (Celexa, Forest Laboratories, NY, NY)
  6. Sertraline (Zoloft, Pfizer, New York, New York)
  7. Paroxetine (Paxil, GlaxoSmithKline, Philadelphia, PA)
  8. Estrogen (Premarin, Wyeth Laboratories, Pfizer, NY, NY)

Here’s more information about hot flashes from our companion website, patientresource.net:

A hot flash is a sudden, intense hot feeling on your face and sometimes upper body. A rapid heartbeat, nausea, dizziness, headache, weakness, and/or sweating may also occur at the same time. A “flush” follows the hot flash; during a flush, you become red and perspire. Hot flashes are perhaps the menopausal symptom that women find the most uncomfortable and inconvenient.

Among the general population of women, hot flashes may last for a year or two after menstrual periods have stopped or may persist for several years. The intensity of hot flashes caused by tamoxifen usually improves after the first 3-6 months of treatment. Hot flashes vary in duration and frequency; most episodes last a few minutes, and they often occur at night, with night sweats often waking up women in the middle of the night.

Hot flashes may have specific triggers. These triggers vary among women, but the most common ones include alcohol, caffeine, spicy food, stress, hot weather, hot showers, and saunas. Identifying and avoiding triggers can help decrease the frequency of hot flashes.

Some suggestions for coping with hot flashes include the following.

* Wear cotton and avoid wool and synthetic materials.
* Dress in layers, so you can remove clothes in layers if needed.
* Keep ice water nearby to drink when a hot flash begins.
* Wear cotton pajamas or a nightgown and use cotton sheets on the bed.
* Take a cool shower before going to bed.
* Open the refrigerator door and put your head in when a hot flash begins.

Some studies have shown that vitamin E or vitamin B6 supplements can help reduce hot flashes. If hot flashes are severe, your doctor may suggest a low dose of an antidepressant. The drug that has been shown to be most effective is venlafaxine (Effexor); paroxetine (Paxil) is another alternative and may be better tolerated by some women. Mild sedatives may also be of benefit but there are risks associated with their use.

Many menopausal women have turned to herbal remedies, such as ginseng, black cohosh, evening primrose oil, licorice root, and others to alleviate hot flashes. However, the safety of these remedies in women with breast cancer has not been determined. Do not take any herbal supplements without talking to your doctor first.

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