Non-hormonal prescription treatments for hot flashes: fezolinetant, elinzanetant and more
Several prescription medicines can ease hot flashes without using hormones. The newest, fezolinetant and elinzanetant, act on a brain pathway that controls body temperature and are approved in the US, UK and EU.
If you take fezolinetant, contact your prescriber right away about yellow skin or eyes, dark urine, pale stools, itching, nausea or upper-right belly pain. These can be signs of liver injury.
What they are
These medicines are options for women who cannot or prefer not to use hormone therapy. They fall into two groups.
- Neurokinin receptor blockers. Fezolinetant (Veozah in the US, Veoza in the EU) blocks the NK3 receptor in the brain's temperature center. Elinzanetant (Lynkuet) blocks both NK1 and NK3 receptors.6
- Older medicines used for hot flashes. These include some antidepressants (SSRIs and SNRIs), gabapentin and oxybutynin.1
In 2023, The Menopause Society recommended SSRIs and SNRIs, gabapentin, oxybutynin and fezolinetant for hot flashes. It did not recommend clonidine or pregabalin.1
What the research shows
Fezolinetant. The SKYLIGHT 1 and 2 trials enrolled 527 and 500 women. Both doses cut hot flash frequency and severity more than placebo. Benefits started in the first week and lasted to 52 weeks. A third, 52-week safety trial enrolled 1,830 women.3
In that year-long trial, about 5% of women on fezolinetant stopped because of side effects, similar to placebo (4.3%). Large rises in liver enzymes were uncommon but did occur.3
Elinzanetant. The OASIS 1 and 2 trials included 796 women. Elinzanetant reduced how often and how severely hot flashes and night sweats happened, compared with placebo. A year-long safety study added 627 women.6
Older medicines. SSRIs, SNRIs, gabapentin and oxybutynin are supported by The Menopause Society for hot flashes.1 Ask a doctor how they compare with the newer medicines for you.
Safety and who should be careful
Fezolinetant and the liver. In December 2024 the FDA added a boxed warning about rare but serious liver injury. It recommends liver blood tests before starting and at set points during the first months of treatment.2 Stop and contact the prescriber if signs of liver injury appear.2
The EU label says fezolinetant should not be taken with medicines that strongly or moderately block the liver enzyme CYP1A2, or in pregnancy.4
Elinzanetant. The US label has no boxed warning. It warns about drowsiness and next-day impairment, liver enzyme rises, pregnancy loss, and seizures in people with a history of seizures. It must not be used in pregnancy.7
In a year-long trial, the most common side effects were headache, tiredness, dizziness and sleepiness. Many medicines, and grapefruit, can change elinzanetant levels through the CYP3A4 enzyme.7 A pharmacist can check your other medicines.
Antidepressants, gabapentin and oxybutynin each have their own side effects and interactions. Discuss these with a doctor or pharmacist, especially if you take breast cancer treatment.
Approval status by country (checked November 2026)
- Fezolinetant: approved in the US in May 2023.2 Authorized across the EU on December 7, 2023.4 In England, NICE recommended it on March 31, 2026, but only when HRT is unsuitable.5
- Elinzanetant: first approved anywhere by the UK regulator, the MHRA, on July 8, 2025.8 Bayer announced US FDA approval on October 24, 2025.6 Authorized across the EU on November 17, 2025. The EU approval also covers hot flashes caused by hormone-blocking treatment for breast cancer.9
- NICE had not published guidance on elinzanetant when we checked. Its review was listed as awaiting development, with no date.10
NICE made no recommendation on fezolinetant for women with breast cancer or other estrogen-sensitive cancers, though it noted a clear unmet need.5
All of these are prescription-only. Availability, cost and insurance cover differ by country.
What it is used for: evidence rated
| Option | Evidence | What the research shows |
|---|---|---|
| Hot flashes (fezolinetant) | Large placebo-controlled trials (527, 500 and 1,830 women) show fewer and milder hot flashes.3 | |
| Hot flashes and night sweats (elinzanetant) | Two placebo-controlled trials with 796 women showed reductions in frequency and severity.6 | |
| Hot flashes (SSRIs and SNRIs) | Recommended for hot flashes by The Menopause Society in 2023.1 | |
| Hot flashes (gabapentin or oxybutynin) | Recommended by The Menopause Society, but side effects can limit use; discuss the trade-offs with a doctor.1 | |
| Hot flashes (clonidine) | The Menopause Society did not recommend clonidine for hot flashes in 2023.1 |
Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.
Related
Sources
- The 2023 nonhormone therapy position statement, press release, The Menopause Society (June 1, 2023)
- FDA adds warning about rare occurrence of serious liver injury with use of Veozah (fezolinetant), US FDA (updated December 16, 2024)
- SKYLIGHT data: Fezolinetant for vasomotor symptoms appears safe, well tolerated, Healio (2023)
- Veoza (fezolinetant): EPAR, European Medicines Agency
- Fezolinetant for treating moderate to severe vasomotor symptoms associated with menopause (TA1143), NICE (March 31, 2026)
- Bayer's Lynkuet (elinzanetant) approved in the US for moderate to severe vasomotor symptoms due to menopause, Bayer (October 24, 2025)
- Lynkuet (elinzanetant) prescribing information, US FDA (revised October 2025)
- MHRA approves elinzanetant to treat moderate to severe vasomotor symptoms caused by menopause, GOV.UK (July 8, 2025)
- Lynkuet (elinzanetant): EPAR, European Medicines Agency (authorized November 17, 2025)
- Elinzanetant for treating vasomotor symptoms associated with menopause [ID6359], NICE