June 14, 2000 ST. PAUL, MN -- Gabapentin, a drug used to prevent migraines and seizures, may offer hope to the millions of women who suffer from menopausal-related hot flashes. According to a case report published in the June 13 issue of Neurology, the American Academy of Neurology's scientific journal, gabapentin may significantly reduce the frequency of hot flashes.
"Anecdotally, gabapentin has certainly been effective for patients who have tried it for hot flashes," said author Thomas Guttuso, Jr, M.D., a neurologist at the University of Rochester Medical Center in Rochester, NY. "It would be reasonable for patients suffering with menopausal or prescription drug induced hot flashes to try gabapentin after consulting with their personal physician."
The article examines the cases of six patients who took gabapentin. Overall, the patients experienced an average 87-percent reduction in the frequency of hot flashes.
The first patient, a 52-year-old woman, reported 10-15 hot flashes per day following a hysterectomy and discontinuation of estrogen due to migraines. Gabapentin was prescribed to prevent migraine. The woman's hot flashes stopped two days after starting gabapentin. To assess the drug's effect on the hot flashes, the woman agreed to stop taking gabapentin. The first day off treatment the woman had 17 hot flashes. She resumed taking the drug the next morning and experienced no more hot flashes.
"Estrogen therapy is currently the main treatment for hot flashes and has proven to be very effective in both medical studies and clinical practice," said Guttuso. "However, the decision-making processes concerning estrogen therapy recommendations have become one of the most controversial topics in medicine today. Gabapentin therapy may prove to be a safe and effective alternative treatment for hot flashes in women who are medically unable to take estrogen therapy or in women whom decide against estrogen therapy for personal reasons."
Another patient, a 58-year-old man diagnosed with prostate cancer, was receiving hormone- altering treatments with the common side effect of hot flashes. He reported about 15 hot flashes a day, most of which occurred at night. Gabapentin taken at bedtime completely ended nighttime hot flashes.
Although the Food and Drug Administration has approved gabapentin only for the treatment of seizures, it is also prescribed for the prevention of migraine and treatment of neuropathic pain disorders, certain types of tremor, anxiety disorders and bipolar disorder. Gabapentin may cause sleepiness, dizziness and clumsiness, however no long-term or harmful side effects have been reported.
Guttuso also examined the case of a 38-year-old man with a history of childhood tuberculosis meningitis resulting in severe mental retardation, seizures and hypothalamic dysfunction causing hypothermia (a dramatic reduction in body temperature) that occurred about once every two years. Gabapentin was prescribed for seizure control. Over the following six months, the man had 23 episodes of hypothermia. Gabapentin was discontinued and the next hypothermic episode occurred 18 months later.
"Although this is only one case report of hypothermia associated with gabapentin use, it would be wise for physicians to avoid gabapentin treatment in patients with known hypothalamic dysfunction with episodes of hypothermia," cautioned Guttuso.
Researchers believe that hot flashes result from a temporary lowering of the body's hypothalamic temperature regulatory set point. This results in a sudden perception of heat and activation of physiological cooling processes, such as sweating and dilation of blood vessels. This may be caused by over-activity of brain cells in this area. Although how gabapentin works is not fully understood, Guttuso believes that the drug decreases this cell activity in the brain's hypothalamus.
A clinical trial to test gabapentin's effect on hot flashes is currently underway.
The American Academy of Neurology, an association of more than 16,500 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research.
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