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    Prozac Shows Promise for Hot Flashes in Breast Cancer Survivors


    Nearly half of the first group of patients reported 4-9 hot flash episodes at enrollment, and half reported 10 or more episodes daily. Two-thirds of the patients were aged 50 or older. During 4 weeks of treatment with Prozac, 53% of the women had hot flashes that were significantly lower in intensity. That compared with 19% of patients taking placebo.

    Upon completion of the two four-week segments of the trial, patients rated their satisfaction with the two treatments. Loprinzi said twice as many patients chose the Prozac over the placebo. And, no differences in side effects were noted between the two options.

    Similar to Prozac, investigation of the newer antidepressant Effexor (venlafaxine) has shown a reduction in hot flashes by half among women who took it.

    At the symposium, Loprinzi offered what amounted to a preview of a trial being conducted by the National Comprehensive Cancer Treatment Group using Effexor, where preliminary findings aren't expected until spring. Still, Loprinzi says early findings show higher doses of Effexor were significantly more effective than placebo at limiting the amounts of hot flashes, often by half.

    Loprinzi also pointed out that a report at the 1998 San Antonio meeting also showed favorable results with the antidepressant Paxil (paroxetine), which is similar to Prozac, for relief of hot flashes in breast cancer patients. Favorable results have been reported for other new generation antidepressants, including Zoloft (sertraline) and Wellbutrin (bupropion).

    During a question-and-answer session at the San Antonio symposium, an unidentified physician in the audience said Paxil is associated with some risk of decreased libido, a side effect common to most drugs in its class of antidepressants. Representatives of breast cancer patient advocacy groups also expressed concern about the use of "powerful, potentially psychotropic (mind-altering) agents to treat hot flashes" when other options are available to breast cancer survivors, including natural therapies such as vitamin E and physical activity.

    In response to the concerns, Loprinzi said, "These patients wanted to participate in this study because they had tried other therapies that hadn't worked. The hot flashes had become extremely bothersome to them, and they were willing to try something different. The patients were fully informed about the use of Prozac."

    Among natural approaches to relieve hot flashes, soy currently generates the most enthusiasm, Loprinzi says.

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