How it works
Neurokinin receptor antagonists are a new class of non-hormonal prescription pills for menopause hot flashes and night sweats. They block neurokinin receptors in the hypothalamus, the part of the brain that regulates body temperature. By interrupting the pathway that triggers hot flashes, they reduce both the frequency and severity of vasomotor symptoms.
Research and approval status
Two neurokinin receptor antagonists are FDA-approved. The FDA approved fezolinetant, an NK3 antagonist, in 2023, and approved elinzanetant, a dual NK1/NK3 antagonist, in 2025. In SKYLIGHT 1 and SKYLIGHT 2, fezolinetant 45 mg reduced daily hot flash and night sweat frequency by 2.53 to 2.55 episodes per day more than placebo at week 12 (p<0.001). In the OASIS 1 and 2 trials, elinzanetant 120 mg reduced daily frequency by about 3.2 episodes per day more than placebo at week 12. The NAMS 2023 position statement lists fezolinetant as a Level I recommendation; the FDA approved elinzanetant in October 2025, after the 2023 statement was published.
Side effects and cautions
Fezolinetant carries an FDA boxed warning about the risk of hepatotoxicity (liver injury). Neurokinin antagonists can affect the liver, so you need baseline liver function blood tests before starting one. With NK3 antagonists such as fezolinetant, tests are repeated monthly for the first 3 months, then again at 6 and 9 months. With dual NK1/NK3 antagonists such as elinzanetant, a repeat test at 3 months is recommended. Do not take an NK3 antagonist if you have known cirrhosis, severe kidney impairment or end-stage kidney disease, or take CYP1A2 inhibitors such as fluvoxamine. Dual NK1/NK3 antagonists are contraindicated in pregnancy and not recommended for people with moderate or severe hepatic impairment or end-stage renal disease. Avoid strong CYP3A4 inhibitors (including grapefruit juice) and strong or moderate CYP3A4 inducers; if you take a moderate CYP3A4 inhibitor, reduce the dose to 60 mg (one capsule). Elinzanetant can cause sleepiness and affect your ability to drive or do hazardous activities the next day, and people with a history of seizures should talk to their clinician before using it.
Where to get it
You need a prescription, which you can get through telehealth or a menopause specialist. You take it as a daily pill. Check our provider directory for clinics near you.
