Randomized, Double-Blind, Placebo-Controlled Crossover Trials of Venlafaxine for Hot Flashes After Breast Cancer

Abstract

LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Discuss the efficacy of venlafaxine in alleviating hot flashes and improving secondary outcomes.2. Identify the week of treatment that venlafaxine was most effective.3. List three side effects associated with venlafaxine.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACT Background. Although venlafaxine reduces self-reported hot flashes, no data have established the drug's impact on physiologically documented hot flashes. Two randomized, double-blind, placebo-controlled crossover trials examined the efficacy of two doses of venlafaxine in relation to physiological and self-reported hot flashes and other outcomes, including negative affect, fatigue, sleep, and quality of life.Methods. Sample: 57 breast cancer survivors in the low-dose study; 20 in the high-dose study. Setting: university cancer clinics in the Southeast and Midwest. Intervention: 37.5 mg of venlafaxine (low-dose study) or 75 mg of venlafaxine (high-dose study). Measures: hot flash frequency (physiological monitor, diary, and event marker), hot flash severity (diary), hot flash bother (diary), and questionnaires for hot flash impact on daily life, negative affect, fatigue, sleep, and quality of life.

Yoga of Awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial

“…The average prerandomization credibility rating across the study participants was high, 8.0 out of potential range of 0.0 to 10.0 (yoga=8.4, SD=1.5; control=7.6, SD=1.9). Many patients were concurrently taking antidepressants or other medications that tend to decrease hot flashes (overall=40.5%, yoga=35.3%, control= 45.0%), and most participants were taking medications that have the contrasting effect of increasing hot flashes, specifically aromatase inhibitors (overall=59.5%, yoga= 58.8%, control=60.0%) or tamoxifen (overall=13.5%, yoga=11.8%, control=15.0%) [5,25]. Along with testing for baseline between-group differences in these two medication categories, an analysis of pre-to postchanges in these categories-scored as increased, decreased, or no change in the number of medications fitting each category [19]-showed no significant differences between treatment conditions at either posttreatment or follow-up.…”

“…We included women taking medications affecting menopausal symptoms (e.g., antidepressants, clonidine) or supplements that might affect their symptoms (e.g., black cohosh, phytoestrogens) because (a) given the pilot nature of this trial and the rapidly growing use of medications and supplements among women experiencing menopausal symptoms [5], we preferred to avoid restricting a significant portion of women from enrolling in the study; and (b) though several antidepressants (e.g., venlafaxine, fluoxetine) have been shown to moderately reduce menopausal symptoms, they do not eliminate them [5], hence our proviso that women be actively experiencing hot flashes assured the possibility that the intervention could further reduce women's symptoms.…”

“…Menopausal symptoms in these women are often especially prevalent and severe, yet hormone therapy is contraindicated for most breast cancer survivors [5,26]. Furthermore, medications commonly used to prevent reoccurrence of breast cancer, such as tamoxifen and aromatase inhibitors, frequently induce or exacerbate menopausal symptoms [5].…”

Long-term Chinese herbs decoction administration for management of hot flashes associated with endocrine therapy in breast cancer patients

“…In one clinical trial, long term use (up to 3 years or longer) of low dose megestrol acetate (< or =20 mg of megestrol acetate per day) showed continued control of hot flashes and well tolerated [24] . Venlafaxine has been the research hotspot for alleviating hot flashes in breast cancer patients, in several clinical trials [20,25,26] , different doses and timing of venlafaxine were administered, it showed effect in alleviating hot flashes, but for long term administration, limited by its side effects, some patients dropped out. According to the results of one open-label crossover study [27] newly published in JCO, breast cancer survivors prefer venlafaxine over gabapentin for the treatment of hot flashes.…”

Tratamiento de los síntomas vasomotores en pacientes con cáncer de mama. Revisión narrativa

“…Los efectos adversos fueron relacionados con mayor dosis y no hubo interacción farmacológi-ca con el metabolismo del tamoxifeno (19) . Tanto la depresión inducida por tamoxifeno como la calidad de vida mejoraron con el uso de venlafaxina (20,21) .…”