Veozah (fezolinetant) for hot flashes

Treating moderate to severe hot flashes and night sweats caused by menopause. It's a non-hormonal pill that works on the brain's temperature control center. It doesn't treat vaginal dryness or protect bone.

In trials, it reduced moderate to severe hot flashes by about 2.5 more per day than placebo at 12 weeks, from an average starting point of 10.4 to 11.8 a day. The benefit appears by week 4. Estrogen is more effective, cutting hot flash frequency by about 75%.

Serious liver injury is rare but possible, which is why it has a boxed warning. You'll need liver blood tests before starting, monthly for 3 months, and at 6 and 9 months, and you should stop it immediately if you notice signs of liver problems.

In trials, it reduced hot flashes more than placebo by week 4, with further benefit at week 12. Give it about 12 weeks before deciding whether it works for you.

It was studied as an alternative to hormones: women who had used HRT stopped it and had a wash-out period before joining the trials. Most women take one or the other, so ask your doctor if you're considering combining them.

It's non-hormonal, so it's an option for many women who can't take estrogen. Discuss it with your oncology team and check for interactions with your other medicines.

The most common were abdominal pain, diarrhea, trouble sleeping, back pain, hot flash and raised liver enzymes. Serious liver injury is rare. Stop it and call your prescriber if you notice unusual tiredness, nausea, itching, yellow skin or eyes, light stools or dark urine.

Around $577.86 for 30 tablets, a month's supply, if you pay cash, depending on the pharmacy. There's no generic. With commercial insurance, the Veozah Savings Card can make the first month $0 and refills $30, up to $4,000 a year. Medicare and Medicaid plans can't use the card.

In 2,122 reports to the FDA, the most common complaint is that it didn't work (250 reports), followed by raised liver enzymes. In trials, it cut hot flashes by about 2.5 a day more than placebo, so results vary from woman to woman. In the same trials, it also made the remaining hot flashes milder.

Take it as soon as you remember, unless your next dose is less than 12 hours away. In that case skip it and go back to your usual schedule the next day. Don't take two tablets to catch up.

Weight gain wasn't among the common side effects listed in the trials. Veozah isn't a hormone, and across three trials endometrial biopsies found hyperplasia or cancer in 1% or less of women on the 45 mg dose. Any bleeding after menopause still needs checking.