Oxybutynin for Hot Flashes

How it works

Oxybutynin is a prescription drug approved for overactive bladder, but it is also used off-label for menopause hot flashes. It blocks acetylcholine receptors in the central nervous system, which may reduce sweating and hot flashes by affecting temperature regulation.

How well it works

A 2016 randomized controlled trial by Simon et al. found that 73% of oxybutynin patients reported their hot flash severity was “much better” at 12 weeks, compared to 26% with placebo. The Menopause Society (NAMS 2023) lists it as a Levels I-II recommendation.

Side effects and cautions

Oxybutynin is not FDA-approved for hot flashes, so this use is off-label. Dry mouth affects over half of users. Other side effects include constipation, dizziness, and drowsiness. Guidelines urge caution in adults over 65 because of anticholinergic cognitive effects — the American Geriatrics Society Beers Criteria list oxybutynin among strongly anticholinergic drugs to avoid in older adults — and long-term use may be associated with increased dementia risk in older adults (Chancellor 2024 review). You should not take oxybutynin if you have narrow-angle glaucoma, urinary retention, gastric retention, or a known allergy to the drug.

Where to get it

You need a prescription, which you can get through telehealth or your primary care provider. Generic oxybutynin is inexpensive and usually covered by insurance. Check our provider directory for clinics near you.