CLONIDINE AND THE ANTIDEPRESSANT
EFFEXOR BOTH REDUCE HOT FLASHES
The modern management of breast cancer often includes “hormonal therapy,” in which medications that block the effects of estrogen, or decrease the amount of estrogen manufactured by the body, are used to reduce the risk of breast cancer recurrence. Despite significantly lowering the risk of breast cancer recurrence in patients with estrogen-sensitive breast tumors, recent clinical research studies have shown that fewer than one-half of all breast cancer patients actually go on to complete the recommended 5-year course of hormonal therapy. (This very poor level of compliance with a medical therapy proven to lower recurrence and death rates associated with breast cancer is particularly an issue among younger women.)
While there are several reasons why more than half of all breast cancer patients do not complete their recommended course of hormonal therapy, one of the major causes, and especially among younger patients, is that these medications are commonly associated with significant side effects, including the same hot flashes that frequently accompany menopause.
Numerous treatment interventions have been tried in an effort prevent hot flashes associated with breast cancer therapy (as well as hot flashes in postmenopausal women without breast cancer), but very few of these therapies have been shown to have any clinically significant benefit. However, several previous clinical studies have suggested that certain types of antidepressant medications, as well as the blood pressure medication clonidine, may reduce the severity and frequency of hot flashes. Unfortunately, much of the research in this area has been of rather low quality, and so the findings of these lower level studies have not radically changed the way that most physicians have managed their patients’ hot flashes. Now, a newly published prospective, randomized, placebo-controlled, blinded clinical research study, which appears in the current issue of the Journal of Clinical Oncology, strongly suggests that venlafaxine (also known by its trade name, Effexor®), a medication that is part of the new “serotonin–norepinephrine reuptake inhibitors” (SNRIs) class of antidepressants, and clonidine may both be effective in decreasing the severity and frequency of hot flashes in women with a history of breast cancer.
In this study, 102 women with a history of both breast cancer and severe hot flashes were secretly and randomly assigned to take either venlafaxine (75 mg per day), clonidine (0.1 mg per day), or an identical-appearing placebo (sugar) pill. Following 12 weeks of observation, 80 patients remained in this clinical study. At the end of this 12-week clinical study, both clonidine and venlafaxine were found to significantly decrease the severity and frequency of hot flashes, when compared to placebo pills. Although both medications were clinically effective in reducing hot flashes, and although venlafaxine resulted in a more rapid reduction in hot flashes than clonidine, clonidine was associated with a greater overall improvement in hot flashes, when compared to venlafaxine, after 12 weeks of treatment. (Venlafaxine was also associated with a greater incidence of nausea, constipation, and appetite loss, compared to clonidine.)
The findings of this study add to those of prior studies that have shown a 15 to 25% reduction in the severity and frequency of hot flashes with antidepressants such as venlafaxine, and with clonidine. Moreover, prior studies have shown that these two medications reduce the severity and frequency of hot flashes in women with a history of breast cancer as well as in postmenopausal women without a prior history of breast cancer.
One important limitation of this study is its small size, and its high patient drop-out rate, which resulted in small numbers of patient volunteers in each of the three “arms” of this prospective, randomized, blinded, placebo-controlled study. However, the findings of this small clinical research study, nonetheless, are still consistent with those of previously published studies; and taken together, these studies suggest that venlafaxine (and other modern antidepressant medications) and clonidine may be effective in reducing the severity and frequency of hot flashes in both breast cancer patients who are undergoing hormonal therapy for their cancer and in postmenopausal women with menopause-associated hot flashes.
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Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity
Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author
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Robert A. Wascher, MD, FACS
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