Menopausal women taking widely prescribed seizure medications may be experiencing an unexpected and unidentified benefit – relief from hormonal hot flashes.
Women bothered by menopause-related hot flashes but reluctant to take hormone replacement therapy may soon have another FDA-approved option available to them. A new extended release version of the anticonvulsant drug gabapentin proved to be effective in both preventing and reducing the severity of hot flashes in two preliminary studies. A third study will be completed in 2011.
Hot flashes, sometimes called hot flushes, are sudden feelings of intense heat that start in the waist or chest and spread upward, sometimes affecting the entire body. They are often accompanied by flushing and sweating, and some women also experience headaches, dizziness, fatigue and heart palpitations. Hot flashes can make it very difficult to get a good night's sleep. Hot flashes are a symptom of changing hormone levels and are commonly associated with menopause, although men can experience hot flashes as a result of low testosterone levels. About 13 million of the estimated 32 million American women who experience hot flashes annually are so troubled by them that they seek treatment.
Long-term hormone therapy is currently the only FDA-approved therapy for hot flashes, but it has been linked to an increased risk of breast cancer, stroke and dementia. The FDA recommends those suffering from hot flashes try alternative treatments such as phytoestrogens (found in soy, yams, ginger and red clover) and lifestyle changes such as avoiding caffeine, spicy foods and alcohol first. Antidepressants have also proven helpful.
If a woman should chose to take hormones, the FDA and the North American Menopause Society recommend she take the lowest possible dose for the shortest possible time. "Having a hot flash drug that does not involve hormones would certainly be beneficial," says NAMS president Dr. Cynthia Stuenkel, "Hormone therapy is the most effective treatment we have, but there are women who should not take it."
The older immediate release gabapentin (best known as brand name Pfizer Neurontin) has been prescribed off label (for a use not approved by the FDA) to treat hot flashes for some time. Studies did find it to be an effective treatment, but 60 percent of those who took it experienced the common Neurontin side effects of dizziness and sleepiness. A new slow release formulation avoids many of these gabapentin side effects. The new extended release gabapentin is marketed as Serada and as Horizant (gabapentin enacarbil).
Gabapentin is an antiseizure drug used to treat epilepsy and to relieve restless leg syndrome. Seizure medications are also widely prescribed as pain relievers, particularly for the relief of postherpetic neuralgia (shingles), migraine headaches, diabetic neuropathy and neuralgia (pain in one or more nerves). Epilepsy drugs relieve seizures by decreasing abnormal excitement in the brain, and relieve pain by changing the way the body senses it.
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