European Journal of Clinical Pharmacology

, Volume 72, Issue 9, pp 1051–1058 | Cite as

Comparative efficacy of nonhormonal drugs on menopausal hot flashes

  • Lujin LiEmail author
  • Ling Xu
  • Junyi Wu
  • Lidan Dong
  • Shuiyu Zhao
  • Qingshan ZhengEmail author



The effects of nonhormonal drugs on menopausal hot flashes are still not well quantified. We therefore did a model-based meta-analysis (MBMA) to quantitate and compare the efficacy features of nonhormonal drugs on menopausal hot flashes.


Literature was searched in the public databases to extract data of clinical trials on nonhormonal drugs, including selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs), gabapentin, clonidine, and soy isoflavones. Pharmacodynamic models were used for the quantitative analysis of each drug.


Thirty-nine studies were included in the analysis. The results revealed a classic pharmacodynamic maximal effect (Emax) model could describe the time course of hot-flash reduction by nonhormonal drugs. After deducting placebo effects, the Emax of SSRIs/SNRIs, gabapentin, clonidine, and soy isoflavones was 13.9 %, 14.8 %, 18.5 %, and 25.0 %, respectively. The time to achieve half of the maximal effect (ET50) of SSRIs/SNRIs, gabapentin, clonidine, and soy isoflavones was 0.18 weeks, 0 weeks, 0 weeks, and 11.6 weeks, respectively. The results showed that SSRIs/SNRIs, gabapentin, and clonidine had a rapid onset, which could reach the maximum effect immediately. However, the onset of soy isoflavones was very slow, and a duration of 16.6 weeks was needed to surpass the efficacy of paroxetine (a type of SSRIs).


The information provided in this study can be used as valuable supplementary information for treatment guidelines of nonhormonal drugs on menopausal hot flashes.


Menopause Hot flashes Nonhormonal agents Model-based meta-analysis 



The authors especially thank Christine M. Derzko (St. Michael’s Hospital, University of Toronto) for valuable contributions to the manuscript. This study was supported by Shanghai Municipal Science and Technology Commission (14CG40, ZY3-CCCX-3-1001) and the Notional Natural Science Funds (81303279).

Compliance with ethical standards

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

Lujin Li designed the work, analyzed data, and wrote the paper. Ling Xu searched papers and analyzed data. Junyi Wu, Lidan Dong, and Shuiyu Zhao contributed to data extraction and cleaning. Qingshan Zheng participated in conception and design of the work and revised the paper critically for important intellectual content.

Supplementary material

228_2016_2090_MOESM1_ESM.doc (1.5 mb)
ESM 1 (DOC 1504 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Center for Drug Clinical ResearchShanghai University of Traditional Chinese MedicineShanghaiChina

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