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Treating Hot Flashes with an Anticonvulsant

Menopausal vasomotor symptoms, which appear to originate in the hypothalamus, can be effectively treated with estrogens and progestins. It can be difficult, however, to manage hot flashes in breast cancer survivors and other patients who cannot or choose not to take sex steroids. Gabapentin is an anticonvulsant also used to treat essential tremor, bipolar disorder, restless leg syndrome, and migraine. Animal data suggest that it is biologically plausible that gabapentin acts at the hypothalamic site responsible for temperature regulation.

In this case series, the author, an academic neurologist, describes 6 adults whose vasomotor symptoms improved during gabapentin treatment: 4 women who had been surgically castrated; 1 woman who took tamoxifen (known to increase vasomotor symptoms in some users); and 1 man with prostate cancer who developed vasomotor symptoms during treatment with a GnRH agonist (known to cause hot flashes in some users). The gabapentin dosages for these patients ranged from 200 mg nightly to 400 mg 4 times daily.

Comment: In placebo-controlled studies of women with vasomotor symptoms, at least one third of placebo users experience symptomatic improvement. The small numbers and the lack of a comparison group in this study preclude the drawing of any conclusions about gabapentin's role in the management of hot flashes. Nonetheless, the suggestion that it is biologically plausible for gabapentin to decrease hot flashes is intriguing. The author noted that a double-blind, placebo-controlled clinical trial of gabapentin's efficacy in the treatment of hot flashes is in progress.

— AM Kaunitz

Published in Journal Watch Women's Health August 21, 2000

Citation(s):

Guttuso TJ. Gabapentin's effects on hot flashes and hypothermia. Neurology 2000 Jun 13 54 2161-2163.

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