How it works
Gabapentin is a prescription drug approved for seizures and nerve pain after shingles (postherpetic neuralgia). It is also used off-label for menopause hot flashes. It binds to a subunit of calcium channels, but how this reduces hot flashes is not known. Pregabalin is a related gabapentinoid, but NAMS 2023 does not recommend it for hot flashes.
How well it works
A 2003 randomized controlled trial by Guttuso et al. found that gabapentin reduced hot flash frequency by 45% at 12 weeks, compared to 29% with placebo. The NAMS 2023 position statement lists gabapentin as a Level I recommendation for hot flashes. Pregabalin, a related gabapentinoid, is not recommended. Because drowsiness is a side effect, NAMS 2023 notes that bedtime dosing may suit women whose sleep is disrupted by hot flashes.
Side effects and cautions
Gabapentin is not FDA-approved for hot flashes, so this use is off-label. Common side effects include drowsiness, dizziness, and fatigue. People with kidney disease need dose adjustments. If you have a history of substance use disorder, talk to your clinician before starting gabapentin, because it can be misused and dependence is possible (Smith 2016 systematic review).
Where to get it
Generic gabapentin is inexpensive. You need a prescription from a clinician, such as your primary care provider. Check our provider directory for clinics near you.
