Hot flashes are a common and often disruptive symptom experienced by many individuals during menopause, significantly affecting daily life and sleep quality. While hormone therapy has been a traditional approach, non-hormonal treatment options are also available. Paroxetine, marketed as Brisdelle, is one such non-hormonal alternative, offering relief from the sudden sensations of heat, sweating, and flushing.
How Paxil Works for Hot Flashes
Paroxetine, the active ingredient in Paxil and Brisdelle, belongs to a class of medications called selective serotonin reuptake inhibitors (SSRIs). These drugs primarily function by increasing the level of serotonin, a neurotransmitter, in the brain. For hot flashes, the mechanism is thought to involve the brain’s thermoregulatory center, which helps control body temperature. By influencing serotonin levels, paroxetine may stabilize this center, thereby reducing the frequency and severity of hot flashes.
The exact way paroxetine achieves this effect for hot flashes is not fully understood, but it is believed to involve central nervous system pathways. While higher doses of paroxetine are approved for various mental health conditions, a specific low-dose formulation of paroxetine mesylate, Brisdelle, received FDA approval specifically for the treatment of moderate to severe hot flashes associated with menopause. This distinguishes its use for hot flashes from its antidepressant applications.
Effectiveness and Dosage
Clinical studies have demonstrated the effectiveness of low-dose paroxetine (Brisdelle) in reducing menopausal hot flashes. For instance, in one study, the 7.5 mg dose of paroxetine reduced hot flash frequency by a mean of 28.9 fewer hot flashes per week compared to placebo, which saw a reduction of 19.0 fewer hot flashes per week at four weeks. Another study showed reductions in hot flash frequency ranging from 33% to 67% with paroxetine compared to 13.7% to 37.8% with placebo over 6 to 12 weeks of treatment. These benefits can include significant reductions in both the frequency and severity of hot flashes.
The recommended dosage for Brisdelle is one 7.5-mg capsule taken once daily at bedtime. Taking it at night can help decrease hot flashes that might interrupt sleep. While some benefits may be noticed within a couple of weeks, the full effect might take around 4 to 12 weeks to become apparent.
Key Considerations for Treatment
Individuals considering paroxetine for hot flashes should be aware of potential side effects. Common side effects can include nausea, fatigue, insomnia, dry mouth, constipation, sweating, and headache.
Less common but more serious side effects, such as serotonin syndrome, can occur, especially if taken with other medications that affect serotonin levels. Symptoms of serotonin syndrome include agitation, rapid heart rate, high blood pressure, and muscle rigidity.
Drug interactions are another important consideration. Paroxetine can interact with certain medications, including tamoxifen, which is used in breast cancer treatment, potentially reducing its effectiveness. It can also increase the risk of bleeding when taken with blood thinners like warfarin, aspirin, or NSAIDs. Additionally, concomitant use with monoamine oxidase inhibitors (MAOIs) is contraindicated due to a heightened risk of serotonin syndrome.
Paroxetine may not be suitable for everyone. Individuals who are pregnant or breastfeeding should not use it. Those with certain heart conditions or glaucoma should also exercise caution, as paroxetine can affect heart rate or increase eye pressure.
When discontinuing treatment, it is important to gradually taper the dose under medical supervision to avoid withdrawal symptoms such as dizziness, nausea, irritability, and anxiety. Consulting with a healthcare provider is essential to discuss medical history, potential risks, and benefits to determine if paroxetine is an appropriate treatment option.