Gabapentin for Hot Flashes

While hormone treatment really works, it carries some long-term risks that, for many women, are unacceptable; they cast around for alternatives – black cohosh, acupuncture, metaclopramide, and so on. Now hope is offered for managing hot flashes with gabapentin, a drug normally used (and approved) for controlling seizures, and relieving the pain of peripheral neuropathy and shingles. Canadian researchers have published a report in the journal Menopause that describes their controlled study.

Two hundred women living in the Toronto area, who were having menopausal symptoms (at least 14 hot flashes a week), were randomly assigned to take gabapentin (300 mg) or placebo, 3 times a day, for 4 weeks. They kept diaries of their symptoms, their quality of life, and any side effects.

Hot flash scores decreased by 51% in the gabapentin group, compared with a 26% decrease in the placebo group. This was associated with an improvement in a quality-of-life measurement. Side effects were reported by the gabapentin group - unsteadiness (14%) and drowsiness (12%) – in the first week, but by the end of the study these had dissipated. The withdrawal rate from the study was 10%, mostly in the first week due to unsteadiness.

Perhaps a clue as to the way gabapentin works in suppressing hot flashes lies in another study, reported in the Journal of Neurology, Neurosurgery, and Psychiatry. High-altitude headache is commonly experienced by newcomers to high-altitude areas. In a double-blind study, 204 volunteers arriving at an altitude of 3,500 m above sea level were given either 600 mg gabapentin, or a placebo. While the incidence (or frequency) of headache was not reduced by gabapentin (43% vs. 55% with placebo), moderate to severe headaches were significantly less with the drug than with placebo (26.5% with gabapentin vs. 41% with placebo).

Obviously gabapentin is extending its range of medical indications. We must keep an eye open to see if it rivals Botox or aspirin!