Lynkuet (elinzanetant) for hot flashes

Lynkuet treats moderate to severe hot flashes and night sweats caused by menopause. It's a non-hormonal capsule that works on the brain's temperature control center, taken as two capsules at bedtime. It doesn't treat vaginal dryness and isn't a sleeping pill, though trials showed better sleep as hot flashes eased.

In OASIS 1 and 2, it cut moderate to severe hot flashes by about 3 a day more than placebo by week 4, and by 3.2 a day more at week 12, from a starting point of 13.4 to 14.7 a day. Estrogen HRT is more effective, cutting hot flash frequency by about 75%.

The most common are headache, fatigue, dizziness and sleepiness, each in 5% or more of women. Abdominal pain, rash, diarrhea and muscle spasms are less common. Rarer but serious: raised liver enzymes and seizures. Stop and call your prescriber if you notice yellow skin or eyes, dark urine or unusual tiredness.

It can. Sleepiness, fatigue or dizziness affected 11.9% of women in trials, compared with 3.5% on placebo, which is why it's taken at bedtime. Some women's driving was impaired the morning after the first dose. If you feel drowsy, don't drive until the effect has worn off.

In trials, hot flashes fell more than on placebo by week 4, the first checkpoint, and the effect held at week 12. Blood levels steady after 5 to 14 days. Give it about 12 weeks before judging whether it works for you.

Around $618.40 for 60 capsules, a 30-day supply, if you pay cash, depending on the pharmacy. There's no generic. With commercial insurance, the maker's copay card can bring it to as little as $25 a month. Uninsured women on lower incomes can apply to the Bayer patient assistance program.

Weight gain isn't listed among Lynkuet's common side effects in the label or the trials. Weight often changes around menopause for other reasons, including muscle loss and shifts in fat distribution, so look at diet, strength training and sleep if the scale moves.

Liver enzymes rose above 3 times normal in 0.6% of women on Lynkuet and 0.4% on placebo, and it has no boxed warning, unlike Veozah. You still need liver tests before starting and at 3 months, and you should stop it if you notice signs of liver problems.

Avoid grapefruit and grapefruit juice: they raise elinzanetant levels. So do strong CYP3A4 blockers such as itraconazole, which must be avoided, and moderate ones, which halve the dose. Carbamazepine and other inducers make it less effective. Show your pharmacist every medicine and supplement you take.

The OASIS 4 trial tested it in women with hot flashes from endocrine therapy for breast cancer, and it cut hot flashes by 3.4 a day more than placebo at week 12. Tamoxifen levels weren't meaningfully changed by elinzanetant. Agree the choice with your oncology team.

No trial has compared them directly. Lynkuet is taken at bedtime and can cause sleepiness; Veozah is one tablet at any time but has a boxed liver warning and more liver tests. Interactions differ too: CYP3A4 for Lynkuet, CYP1A2 for Veozah. See the full comparison.