How it works
Low-dose paroxetine (7.5 mg) is approved by the FDA for moderate to severe hot flashes (vasomotor symptoms) associated with menopause. It is an SSRI that blocks the reuptake of serotonin, but how it reduces hot flash frequency and severity is not known.
How well it works
In two Phase 3 trials with 1,174 women, paroxetine 7.5 mg reduced daily hot flash frequency by a median of 5.6 to 5.9 episodes per day at 12 weeks, compared to 3.9 to 5.0 with placebo. The median treatment difference was 0.9 to 1.7 episodes per day. The NAMS 2023 position statement lists it as a Level I recommendation. Other SSRIs and SNRIs are also used off-label for hot flashes, but low-dose paroxetine has FDA approval for this use.
Side effects and cautions
Paroxetine carries an FDA boxed warning about suicidal thoughts and behaviors, which applies to antidepressants including the low dose used for hot flashes. Paroxetine should not be taken within 14 days of using an MAOI antidepressant or with thioridazine or pimozide. If you take tamoxifen for breast cancer, the label advises considering avoiding paroxetine, because paroxetine inhibits the CYP2D6 enzyme that converts tamoxifen to its active form and may make tamoxifen less effective. Common side effects include nausea, headache, and fatigue or malaise.
Where to get it
You need a prescription from a clinician, such as your primary care provider. You take it as a daily pill at bedtime. Check our provider directory for clinics near you.
