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Pharmacological and non-hormonal treatment of hot flashes in breast cancer survivors: CEPO review and recommendations



Breast cancer patients frequently report hot flashes. Given that conventional hormone replacement therapy is generally contraindicated for them, other therapeutic modalities must be considered. The purpose of this review was to develop evidence-based recommendations on non-hormonal pharmacological interventions, including natural health products, for managing hot flashes in women undergoing treatment for breast cancer or with a history of breast cancer.


A review of the scientific literature published between January 2000 and December 2011 was performed. A total of 26 randomized trials were identified.


Studies showed that serotonin–norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, antihypertensives and anticonvulsants significantly reduced the frequency and severity of hot flashes in breast cancer patients.


Considering the evidence available to date, the CEPO recommends the following: (1) for breast cancer patients being treated with tamoxifen: (a) the use of venlafaxine, citalopram, clonidine, gabapentin and pregabalin be considered effective in treating hot flashes and (b) the use of paroxetine and fluoxetine be avoided, given that they may reduce the efficacy of tamoxifen; (2) for breast cancer patients not being treated with tamoxifen: (a) the use of venlafaxine, paroxetine, citalopram, clonidine, gabapentin and pregabalin be considered effective in treating hot flashes and (b) fluoxetine not be used to treat hot flashes, given that there is insufficient evidence for its therapeutic efficacy and (3) for breast cancer survivors, sertraline, phytoestrogens, black cohosh and St. John’s wort not be used to treat hot flashes.

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The CEPO is a group of oncology specialists that reports to the Direction québécoise de cancérologie du ministère de la Santé et des Services sociaux du Québec. La Direction québécoise de cancérologie provided funding for the work reported in this article, which is an adaptation of CEPO’s original clinical practice guideline published in June 2012, available in French at www.msss.gouv.qc.ca/cancer. The CEPO would like to thank Jamil Asselah MD, Montreal General Hospital (MUHC); Amélie Chartier B.Pharm./M.Sc./BCOP, Montreal General Hospital (MUHC); Renée Simon MD, Hôpital Charles LeMoyne; Dominique Synnott MD, Hôpital du Sacré-Cœur de Montréal and Lucie Vaillancourt MD, Hôpital du St-Sacrement (CHU de Québec) for their contribution as external reviewers for the original clinical practice guideline.


The authors have no financial conflicts of interest to declare.

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Correspondence to Suzanne Frenette.

Additional information

Members of the Comité de l’évolution des pratiques en oncologie (CEPO): Karine Almanric B.Pharm./M.Sc./BCOP, Hôpital Cité de la Santé de Laval; Gino Boily Ph.D., CEPO; Philippe Bouchard B.Pharm./M.Sc./BCOP, Hôpital Maisonneuve-Rosemont; Jim Boulanger Ph.D, CEPO; Ghislain Cournoyer MD, Hôpital régional de Saint-Jérôme (CSSS de Saint-Jérôme); Félix Couture MD, Hôtel-Dieu de Québec (CHU de Québec); Suzanne Frenette B.Pharm./M.Sc./BCOP, Hôpital Maisonneuve-Rosemont; Normand Gervais MD, Centre hospitalier régional du Grand-Portage (CSSS de Rivière-du-Loup); Stéphanie Goulet Ph.D., Direction québécoise de cancérologie (MSSS); Marie-Pascale Guay B.Pharm./M.Sc./BCOP, Jewish General Hospital (MUHC); Mélanie Kavanagh Ph.D., Direction québécoise de cancérologie (MSSS); Sylvain L’Espérance Ph.D., CEPO; Julie Lemieux MD, Hôpital du Saint-Sacrement (CHU de Québec); Bernard Lespérance MD, Hôpital du Sacré-Cœur de Montréal; Nathalie Letarte B.Pharm./M.Sc./BCOP, Hôpital Notre-Dame (CHUM); Mélanie Morneau M.Sc./MBA, Direction québécoise de cancérologie (MSSS); Jean-François Ouellet MD, Hôtel-Dieu de Québec (CHU de Quebec); Gilles Pineau MD, INESSS; Raghu Rajan MD, Montreal General Hospital (MUHC); Isabelle Roy MD, Hôpital Notre-Dame (CHUM); Benoît Samson MD, Hôpital Charles LeMoyne; Lucas Sideris MD, Hôpital Maisonneuve-Rosemont; Lucie Surprenant B.Pharm./M.Sc./BCOP, Centre hospitalier St. Mary’s; François Vincent MD, Pavillon Sainte-Marie (CSSS de Trois-Rivières).

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L’Espérance, S., Frenette, S., Dionne, A. et al. Pharmacological and non-hormonal treatment of hot flashes in breast cancer survivors: CEPO review and recommendations. Support Care Cancer 21, 1461–1474 (2013). https://doi.org/10.1007/s00520-013-1732-8

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  • Hot flashes
  • Breast cancer
  • Antidepressants
  • Antihypertensives
  • Anticonvulsants
  • Natural health products