A new study has reported that venlafaxine (Effexor, a serotonin-norepinephrine reuptake inhibitor antidepressant) is more effective than gabapentin (Neurontin, an epilepsy medicine) in relieving hot flashes among breast cancer survivors. Nonhormonal treatments are recommended for the treatment of hot flashes in breast cancer survivors since hormone replacement treatment (HRT) has been linked to increased risk of breast cancer. Both antidepressants and gabapentin have been shown to be effective and well tolerated; however, it has not been determined which is preferred by patients. The trial initially included 66 postmenopausal women with at least 14 bothersome hot flashes per week (two per day) during the previous month. The women were randomized to receive four weeks of venlafaxine (37.5 mg daily for seven days followed by 75 mg daily for 21 days) or gabapentin (300 mg once per day for three days, then 300 mg twice per day for three days, then 300 mg three times per day for 22 days) or the reverse sequence of treatments. Eight of the women dropped out before completing the trial.

Participant preference, hot flashes and side effects were compared between the two treatments. Of the 58 remaining participants, 18 (31%) preferred gabapentin and 38 (66%) preferred venlafaxine and two had no preference. Both treatments were found to reduce hot flashes to a similar extent, namely, a 66% reduction. Treatment with venlafaxine was associated with increased nausea, loss of appetite, constipation, and reduced negative mood changes compared with gabapentin. On the other hand, gabapentin was associated with increased dizziness and increase in appetite compared with venlafaxine. The authors conclude that breast cancer survivors prefer venlafaxine over gabapentin for treating hot flashes.