Use of Gabapentin for the Management of Natural or Surgical Menopausal Hot Flashes

Abstract

Spanish

French

Objective:

To review the literature examining the use of gabapentin for treatment of hot flashes during natural or surgically Induced menopause.

Data Sources:

A literature search was conducted via PubMed, MEDLINE, and International Pharmaceutical Abstracts (1948-November 2010) using the search terms gabapentin, hot flashes, and menopause. Literature was limited to English-language, human studies. Additional material was identified by reviewing reference citations of the articles retrieved.

Study Selection and Data Extraction:

Studies with data describing gabapentin for hot flash management during natural or surgically induced menopause were included. Any studies including women with a history of breast cancer were excluded. Four studies met the inclusion criteria.

Data Synthesis:

Gabapentin significantly decreased hot flash frequency and hot flash composite scores by 45-71% from baseline in the 4 trials included in this review. In 2 of the trials, gabapentin was comparable to hormone replacement therapy (71 % vs 72%, respectively, p = 0.63) in decreasing hot flash composite scores at the end of 12 weeks and in decreasing hot flash frequency at the end of 8 weeks (58.9% vs 70.1 %, p > 0.05). In all trials, the most common adverse effects with gabapentin were somnolence/drowsiness, unsteadiness, and dizziness. These adverse effects were most pronounced during the first 1-2 weeks of therapy, but resolved and were similar to those reported with placebo by week 4. These trials were short (<12 weeks) and had small sample sizes; however, their results appear to show that gabapentin is safe and effective for short-term treatment of hot flashes in women who have entered menopause either naturally or surgically.

Conclusions:

Gabapentin 600-2400 mg/day in divided doses may be a viable option for treating hot flashes in menopausal women who do not want to use hormone replacement therapy.

Keywords

gabapentin hot flashes menopause

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References

Treatment of menopause-associated vasomotor symptoms: the North American Menopause Society. Menopause 2004; 11:11–33. DOI 10.1097/01.GME.0000108177.85442.71

Freedman

. Pathophysiology and treatment of menopausal hot flashes. Semin Reprod Med 2005; 23:117–25. DOI 10.1055/s-2005-86947910.1097/gme.0b013e31817b076a

Shanafelt

, Barton

, Adiei

, Loprinizi

. Pathophysiology and treatment of hot flashes. Mayo Clinic Proc 2002; 77:1207–18. DOI 10.4065/77.11.1207

Rossouw

, Anderson

, Prentice

.; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy menopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002; 288:321–33. DOI 10.1001/jama.288.3.321

Guttuso

. Gabapentin's effects on hot flashes and hypothermia. Neurology 2000; 54:2161–2163.

Albertazzi

, Bottazzi

, Purdie

. Gabapentin for the management of hot flushes: a case series. Menopause 2003; 10:214–7. DOI 10.1097/00042192-200310030-00007

Guttuso

. Hot flashes refractory to HRT and SSRI therapy but responsive to gabapentin. J Pain Symptom Manage 2004; 27:274–6. DOI 10.1016/jjpainsymman.2003.07.007

Pandya

, Thummala

, Griggs

. Pilot study using gabapentin for tamoxifen-induced hot flashes in women with breast cancer. Breast Cancer Res Treat 2004; 83:87–9. DOI 10.1023/B.BREA.0000010676.54597.22

Pandya

, Morrow

, Roscoe

. Gabapentin for hot flashes in 420 women with breast cancer: a randomized double blind placebo-controlled trial. Lancet 2005; 366:818–24. DOI 10.1016/S0140-6736(05)67215-7

10.

Biglia

, Sgandurra

, Peano

. Non-hormonal treatment of hot flushes in breast cancer survivors: gabapentin vs vitamin E. Cilmacteric 2009; 12:310–8. DOI 10.1080/136971300902736921

11.

Guttuso

Jr , Kurlan

, McDermott

, Kieburtz

. Gabapentin's effects on hot flashes in postmenopausal women: a randomized controlled trial. Obstet Gynecol 2003; 101:337–45. DOI 10.1016/S0029-7844(02)02712-6

12.

Reddy

, Warner

, Guttuso

. Gabapentin, estrogen and placebo for treating hot flushes. A randomized controlled trial. Obstet Gynecol 2006; 108:41–48.

13.

Butt

, Lock

, Lewis

, Ross

, Moineddin

. Gabapentin for the treatment of menopausal hot flashes: a randomized controlled clinical trial. Menopause 2008; 15:310–8. DOI 10.1097/gme.0b013e3180dca175

14.

Aguirre

, Chedraui

, Mendoza

, Ruilova

. Gabapentin vs low dose transdermal estradiol for treating postmenopausal women with moderate to very severe hot flushes. Gynecol Endocrinol 2010; 26:333–337. DOI 103109/09513590903511539

15.

MacLennan

, Broadbent

, Lester

, Moore

. Oral oestrogen and combined oestrogen/progesten therapy versus placebo for hot flushes. Cochrane Syst Rev 2004(4):CD002978. DOI 10.1002/14651858.CD002978.pub2

16.

Stearns

, Issacs

, Rowland

. A pilot trial assessing the efficacy of paroxetine hydrochloride (Paxil) in controlling hot flashes in breast cancer survivors. Ann Oncol 2000; 11:17–22. DOI 10.1023/A:1008382706068

17.

Stearns

, Slack

, Greep

. Paroxetine is an effective treatment for hot flashes: results from a prospective randomized clinical trial. J Clin Oncol 2005; 23:6919–30. DOI 10.1200/JCO.2005.10.08

18.

Soares

, Joffe

, Viguera

. Paroxetine versus placebo for women in midlife after hormone discontinuation. Am J Med 2008; 121:159–62. DOI 10.1016/j.amjrned.2007.10.007

19.

Loprinzi

, Kugler

, Sloan

. Venlafaxine in the management of hot flashes in survivors of breast cancer a randomized controlled trial. Lancet 2000; 356:2059–63. DOI 10.1016/S0140-6736(00)03403-6

20.

Barton

, La

, Loprinzi

, Novonty

, Wilwerding

, Sloan

. Venlafaxine for the control of hot flashes: results of a longitudinal continuation study. Oncol Nurs Forum 2002; 29:33–40. DOI 10.1188/02.ONE33-40

21.

Carpenter

, Storniolo

, Johns

. Randomized, double-blind, placebo-controlled crossover trial of venlafaxine for hot flashes after breast cancer. Oncologist 2007; 12:124–34. DOI 10.1634/theoncologist.12-1-124

22.

Loibl

, Schwedler

, Von Minckwitz

, Strohmeier

, Menta

, Kaufmann

. Venlafaxine is superior to Clonidine as treatment of hot flashes in breast cancer patients—a double blind, randomized study. Ann Oncol 2007; 18:689–93. DOI 10.1093/annonc/md1478

23.

Loprinzi

, Levitt

, Barton

. Phase III comparison of depome-droxyprogesterone acetate to venlafaxine for managing hot flashes: North Central Treatment Group trial N99C7. J Clin Oncol 2006; 24:1409–14. DOI 10.1200/JCO.2005.04.7324

24.

Evans

, Pritts

, Vittinghoff

, McClish

, Morgan

, Jaffe

. Management of postmenopausal hot flushes with venlafaxine hydrochloride: a randomized controlled trial. Obstet Gynecol 2005; 105:161–6. DOI 10.1097/01.AOG.0000147840.06947.46

25.

Ladd

, Newport

, Raga

, Loughhead

, Stowe

. Venlafaxine in the treatment of depressive and vasomotor symptoms in women with perimenopausal depression. Depress Anxiety 2005; 22:94–7. DOI 10.1002/da.20085

26.

Newton

, Reed

, LaCroix

. Treatment of vasomotor symptoms of menopause with black cohosh, multibotanicals, soy, hormone therapy or placebo. Ann Intern Med 2006; 145:869–879.

27.

Pockaj

, Gallagher

, Loprinzi

. Phase III double-blind, placebo-controlled, crossover trial of black cohosh in the management of hot flashes: NCCTG trial NOICC. J Clin Oncol 2006; 24:2836–41. DOI 10.1200/JCO.2005.05.4296

28.

Pockaj

, Loprinzi

, Sloan

. Pilot evaluation of black cohosh for the treatment of hot flashes in women. Cancer Invest 2004; 22:515–21. DOI 10.1081/CNV-200026394

29.

Vermes

, Banhidy

, Acs

. The effects of Remifemin on subjective symptoms of menopause. Adv Ther 2005; 22:148–54. DOI 10.1007/BF02849885

30.

Hernández Muñoz

, Pluchino

. Cimicifuga racemosa for the treatment of hot flushes in women surviving breast cancer. Matruritas 2003; 44(suppl 1):S59–65. DOI 10.1016/SO378-5122(02)00349-3

31.

Wuttke

, Seidlova-Wuttke

, Gorkow

. The Cimicifuga preparation BNO 1005 vs conjugated estrogens in double-blind placebo-controlled study: effects on menopause symptoms and bone markers. Maturitas 2003; 44(suppl 1):S67–77. DOI 10.1016/SO378-5122(02)00350-X

32.

Nappi

, Malavasi

, Brundu

, Facchinetti

. Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol. Gynecol Endocrinol 2005; 20:30–5. DOI 10.1080/09513590400020922

33.

Oktem

, Eroglu

, Karahan

. Black cohosh and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized trial. Adv Ther 2007; 24:448–61. DOI 10.1007/BF02849914

34.

Bai

, Zepelin

, Wang

. Efficacy and tolerability of a medicinal product containing an isopropanolic black cohosh extract in Chinese women with menopausal symptoms: a randomized, double blind, parallel-controlled study versus tibolone. Maturitas 2007; 58:31–41. DOI 10.1016/j.maturitas.2007.04.009

35.

Frei-Kleiner

, Schaffner

, Rahlfs

. Cimicifuga racemosa dried ethanolic extract in menopausal disorders: a double blind placebo-controlled clinical trial. Maturitas 2005; 51:397–404. DOI 10.1016/j.maturitas.2004.10.003

36.

Lethaby

, Brown

, Marjoribanks

. Phytoestrogens for vasomo for menopausal symptoms. Cochrane Syst Rev 2007; 4:1–64. DOI 10.1002/14651858.CD001395.pub3

37.

Package insert. Neurontin (gabapentin). New York, NY: Pfizer, Inc., July 2010. http://www.pfizer.vom/files/products/uspi_neurontin.pdf (accessed 2010 Nov 19).