If you are looking for a non hormonal treatment for hot flashes, fezolinetant may be an option for moderate to severe symptoms related to menopause. It is a prescription medicine, sold in the United States as Veozah, and it works differently from hormone therapy. Its benefits need to be weighed against a rare but serious risk of liver injury, so treatment includes blood tests and attention to warning symptoms.
WHO may be offered fezolinetant?
Fezolinetant is intended for moderate to severe menopausal vasomotor symptoms: hot flashes and night sweats. A clinician may discuss it if these symptoms are disrupting your life and you prefer not to use hormone therapy, or hormone therapy is not suitable for you. It is not a treatment for every menopause-related concern, such as vaginal or urinary symptoms.
In the United States, the usual dose is one 45 mg tablet once a day. The U.S. FDA label says not to use it if you have known cirrhosis, severe kidney impairment or end-stage kidney disease, or take a medicine that inhibits CYP1A2. Your health history and full medication list matter before you start. If menopause symptoms occur because of ovarian insufficiency before age 40, care may involve different considerations; see this guide to primary ovarian insufficiency and hormone therapy before 40.
Is fezolinetant a non hormonal treatment for hot flashes?
Yes. Fezolinetant blocks the neurokinin 3 (NK3) receptor, which is involved in the brain’s regulation of body temperature. It does not supply hormones. The aim is to reduce hot flashes by changing this signaling pathway.
In clinical trials supporting U.S. approval, women taking fezolinetant had fewer and less severe symptoms than women taking placebo. That means the medicine helped on average beyond the improvement seen with placebo; it does not mean symptoms disappear or that everyone benefits. Trial results compare groups and cannot predict exactly how much relief one person will get. Common side effects reported in the U.S. label include abdominal pain, diarrhea, insomnia and back pain.
Why liver tests are part of treatment
Fezolinetant can raise liver enzymes, and rare but serious liver injury has been reported after the medicine reached the market. In the clinical trials described in the U.S. label, liver enzyme levels more than three times the upper limit of normal occurred in 2.3% of women taking fezolinetant and 0.9% taking placebo. Those test changes are not the same as serious liver injury, but they help explain why monitoring matters. In December 2024, the FDA added a boxed warning about rare serious liver injury.
Under the current U.S. FDA directions, a clinician checks liver blood tests before treatment, then monthly for the first three months, and again at months six and nine. The U.S. label says not to start if ALT or AST is at least twice the upper limit of normal, or if bilirubin is elevated. These tests can identify changes before you feel unwell; they do not remove the need to notice symptoms between appointments.
Contact your prescriber promptly if you develop unusual tiredness, nausea, vomiting, itching, pale stools, dark urine, yellow skin or eyes, swelling in your abdomen, or pain in the upper right abdomen. FDA advice is to stop taking the medicine immediately and contact the clinician who prescribed it if these signs suggest liver injury. Do not wait for your next scheduled blood test.
Check medicines and local guidance
Because CYP1A2 inhibitors can interact with fezolinetant, have a clinician or pharmacist review every prescription medicine, over-the-counter product and supplement you use before starting, and check again when a medicine changes. Do not assume a product is safe to combine just because it is not a prescription.
The detailed monitoring schedule and contraindications above describe U.S. FDA directions. UK, EU and Australian readers should check the current product information for their country or ask a pharmacist or prescriber to confirm local instructions; do not assume the U.S. schedule or restrictions automatically apply. If you are considering fezolinetant, discuss your symptoms, medical history, other medicines and ability to attend blood tests with a clinician.