Use of gabapentin in patients experiencing hot flashes

Hot flashes occur frequently in menopausal women and in women with breast cancer, diminishing their quality of life. A report from the Women's Health Initiative published in 2002 raised concerns about the long-term safety of estrogen therapy. As a result, nonhormonal alternatives have emerged as preferred treatments. Gabapentin is an anticonvulsant that the United States Food and Drug Administration approved as an adjunct therapy for partial seizures and postherpetic neuralgia. Somnolence, dizziness, ataxia, fatigue, nystagmus, and peripheral edema are adverse effects commonly associated with gabapentin in the treatment of epilepsy and postherpetic neuralgia. The North American Menopause Society and the American College of Obstetricians and Gynecologists recommend the use of gabapentin as an option for managing hot flashes in women who are unwilling to take estrogen-containing supplements. To evaluate the efficacy and safety of gabapentin for the treatment of hot flashes in women with menopause and/or breast cancer, we performed a search of the MEDLINE database (1966-March 2008) and International Pharmaceutical Abstracts, as well as manually searching reference articles for relevant articles and abstracts; 10 clinical studies were identified. Although the studies were few, all showed gabapentin to be safe and effective in the treatment of hot flashes. At doses used to control hot flashes, gabapentin was well tolerated, with drowsiness as its most reported adverse effect. Gabapentin can be considered effective in the treatment of hot flashes and should be considered a reasonable alternative when estrogen therapy is not desired.