Presenter: Charles L Loprinzi Affiliation: North Central Cancer Treatment Group, Rochester, MN
Background: Hot flashes can be a significant problem for many cancer patients. Unconventional treatments such as vitamin E and soy have been shown to be only marginally better than a placebo in controlling such symptoms. Estrogen and progesterone replacement therapies, while very effective in the reduction of hot flashes, are used cautiously because of concerns that these substances may induce other tumor growth. This study is a randomized clinical trial evaluating the effectiveness of venlafaxine in reduction of hot flashes.
Materials and Methods:
180 women with hot flashes (both those with and without a history of breast cancer) were randomized to 4 study arms.
Venlafaxine doses were 37.5 mg. per day, 75 mg per day, or 150 mg/day. Patients were treated for 4 weeks. -Hot flashes were measured by a daily hot flash diary, other points evaluated included toxicity, depression, and sexual function.
The placebo group showed an average of 25% reduction in hot flashes vs. pre-study baseline measures
Those taking venlafaxine 37.5 mg daily showed 40% reduction in hot flashes
Those taking venlafaxine 75 mg daily showed 60% reduction in hot flashes
Those taking venlafaxine 150 mg daily showed no difference than those taking 75 mg daily.
There was an increased incidence of mouth dryness, decreased appetite, and nausea with increased dosage. Constipation was seen in those patients taking 150 mg per day. Libido typically improved for patients in all groups.
Less than 7% of these patients stopped taking the medication because of side effects.
75 mg. per day of venlafaxine is the most effective dose in the amelioration of hot flashes.
While this dose is quite well tolerated in most patients, it is associated with increased incidence of anorexia, nausea, and mouth dryness in a small population of patients.
This study shows that the anti-depressant, venlafaxine, is a reasonable alternative to estrogen replacement therapy in the effective treatment of hot flashes.
Sep 14, 2011 - Venlafaxine and clonidine effectively manage hot flashes in patients with breast cancer, with hot flash scores reducing more immediately with venlafaxine than clonidine, and reducing more significantly with clonidine during week 12 of treatment than with venlafaxine, according to a study published online Sept. 12 in the Journal of Clinical Oncology.