title: Pharmacological and non-hormonal treatment of hot flashes in breast cancer survivors: CEPO review and recommendations.
abstract: OBJECTIVE
  Breast cancer patients frequently report hot flashes. Given that conventional hormone replacement therapy is generally contraindicated for them, other therapeutic modalities must be considered. The purpose of this review was to develop evidence-based recommendations on non-hormonal pharmacological interventions, including natural health products, for managing hot flashes in women undergoing treatment for breast cancer or with a history of breast cancer.
  
  
  METHODS
  A review of the scientific literature published between January 2000 and December 2011 was performed. A total of 26 randomized trials were identified.
  
  
  RESULTS
  Studies showed that serotonin-norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, antihypertensives and anticonvulsants significantly reduced the frequency and severity of hot flashes in breast cancer patients.
  
  
  CONCLUSIONS
  Considering the evidence available to date, the CEPO recommends the following: (1) for breast cancer patients being treated with tamoxifen: (a) the use of venlafaxine, citalopram, clonidine, gabapentin and pregabalin be considered effective in treating hot flashes and (b) the use of paroxetine and fluoxetine be avoided, given that they may reduce the efficacy of tamoxifen; (2) for breast cancer patients not being treated with tamoxifen: (a) the use of venlafaxine, paroxetine, citalopram, clonidine, gabapentin and pregabalin be considered effective in treating hot flashes and (b) fluoxetine not be used to treat hot flashes, given that there is insufficient evidence for its therapeutic efficacy and (3) for breast cancer survivors, sertraline, phytoestrogens, black cohosh and St. John's wort not be used to treat hot flashes.
authors: Comité de l'évolution des pratiques en oncologie, 1195, avenue Lavigerie, suite 100, Québec, Québec, Canada, G1V 4N3.
authors: Sylvain
authors: S
authors: L'Espérance
authors: Suzanne
authors: S
authors: Frenette
authors: Anne
authors: A
authors: Dionne
authors: Jean-Yves
authors: JY
authors: Dionne
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000150:complications* / Q000628:therapy; D004347:Drug Interactions; D019317:Evidence-Based Medicine; D005260:Female; D019584:Hot Flashes / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D017741:Survivors; D013629:Tamoxifen / Q000627:therapeutic use
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen