When hormone replacement therapy is not an option for patients with hot flashes, gabapentin (Medication Neurontin, Pfizer), usually prescribed for pain, might be a solution.
A patient at the University of Buffalo was experiencing severe hot flashes 20 to 30 times a day after a hysterectomy and a salpingo-oophorectomy at age 32. Her nighttime sleep was disrupted. Conjugated estrogens and selective serotonin reuptake inhibitors (SSRIs), which are used to treat depression, had no effect.
Her physician prescribed gabapentin 300 mg three times daily and removed an drug estradiol patch that she had been wearing. Within three weeks, the hot flashes were dramatically reduced, to only a few a day. A month later, they became more frequent again, and the gabapentin dosage was raised to four times daily, with positive results. The patient’s sleep improved, and she experienced no side effects.
Gabapentin, estrogen, and SSRIs may all target different cellular sources of the flushing.