How does the new drug Veozah for hot flashes work?

May 22, 2023.

medically reviewed by Patricia Shelton, MD

What you should know about the new non-hormonal medication Veozah for hot flashes

It’s very common to experience a variety of symptoms during the menopausal transition. One of the most common types are what doctors call vasomotor symptoms – hot flashes and night sweats. For some women, these are extremely disruptive, interfering with her sleep and her ability to live her life. In fact, up to 80% of women experience vasomotor symptoms, and a majority of these rate them as being moderate to severe.

The good news is that vasomotor symptoms usually disappear eventually, after you’ve finished going through menopause. However, women who are suffering often don’t want to wait for years to get their lives back. This explains why vasomotor symptoms are the most common symptom that women seek medical treatment for during menopause. Many women are looking for relief.

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Until now, there was really only one effective option – hormone therapy. Taking estrogen is very effective for vasomotor symptoms. However, there are some women who can’t take estrogen for medical reasons, and others who prefer to avoid it. 

We now have a new non-hormonal option that’s effective for reducing hot flashes and night sweats. The FDA has recently approved a medication called fezolinetant (sold under the brand name Veozah™) for treating vasomotor symptoms of menopause. How does this new treatment option work? If you’re considering trying it, what should you know about this new medication?

How does Veozah work?

To understand how Veozah works, we first need to discuss why hot flashes and night sweats happen. Body temperature is regulated in the hypothalamus, which is a specific area of the brain. In the hypothalamus, the balance of two substances is important. One of these is estrogen, and the other is a substance called neurokinin B (NKB). As long as the two are in balance, body temperature should generally remain within a normal range.

During the perimenopausal period, levels of estrogen begin to fluctuate. When estrogen levels drop, the balance between NKB and estrogen in the hypothalamus is disrupted. Because of this imbalance, cells in the hypothalamus may receive the signal that the body is hot, even though it’s not. This can lead to a hot flash or a night sweat. 

Bringing the actions of estrogen and NKB back into balance can help to prevent this problem. One way to do this is to add more estrogen, which is how hormone replacement therapy works. However, instead of adding more estrogen, you could also block the actions of NKB. This is how Veozah works. It blocks neurokinin receptors, so that NKB is less able to act on the hypothalamus. This brings estrogen and NKB back into balance, preventing the hypothalamus from receiving a false signal that the body is hot. Veozah is the first drug to work in this way.

How well does Veozah work?

Veozah has been shown to be effective. In one of the large Phase 3 studies, the medication reduced the number of moderate to severe hot flashes or night sweats a woman experienced each day by more than half. 

Is Veozah safe?

Although side effects with Veozah are not common, the FDA does warn that it causes a small risk of liver problems. It’s recommended that women be tested for possible liver disease before they start taking it, and get a blood test to check their liver health every three months for the first nine months. About 2% of women will experience liver issues from Veozah. However, a large study found that no cases of severe drug-induced liver injury. If this happens to you, your liver will generally recover after you stop taking it.

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Avis NE, Crawford SL, Green R. Vasomotor Symptoms Across the Menopause Transition: Differences Among Women. Obstet Gynecol Clin North Am. 2018 Dec; 45(4): 629–640. doi: 10.1016/j.ogc.2018.07.005

Astellas’ VEOZAH (fezolinetant) Approved by U.S. FDA for Treatment of Vasomotor Symptoms Due to Menopause | Astellas

FDA Approves Novel Drug to Treat Moderate to Severe Hot Flashes Caused by Menopause | Food and Drug Administration

DePree B, Houghton K, Shiozawa A, et al. Treatment and resource utilization for menopausal symptoms in the United States: a retrospective review of real-world evidence from US electronic health records. Menopause. 2023 Jan; 30(1): 70–79. doi: 10.1097/GME.0000000000002095

Johnson KA, Martin N, Nappi RE, et al. Efficacy and Safety of Fezolinetant in Moderate-to-Severe Vasomotor Symptoms Associated With Menopause: A Phase 3 RCT. J Clin Endocrinol Metab. 2023 Feb 3;dgad058. doi: 10.1210/clinem/dgad058.

Neal-Perry G, Cano A, Lederman S, Nappi R, et al. Safety of Fezolinetant for Vasomotor Symptoms Associated With Menopause: A Randomized Controlled Trial. Obstet Gynecol. 2023 Apr 1;141(4):737-747. doi: 10.1097/AOG.0000000000005114.

Disclaimer: This is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment. 

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Patricia Shelton

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