Hot flashes (aka Power Surges) result from a sudden flush of blood to the skin. They occur when the normal hormone levels are reduced. In women this occurs at menopause, either natural, surgical, or chemically induced. In men this occurs at castration, either surgical or chemical, usually in association with treatment for prostate cancer. The hot flashes are generally corrected by replacing the missing hormone, estrogen for women, testosterone for men. Because such hormone replacement is generally inadvisable in people with hormone sensitive cancers, other solutions must be found. Hot Fashes do not affect everyone the same. Some women have very few symptoms while others are severely impacted. Hot flashes often go away by themselves as the body adapts to the new hormonal milieu. Until they do resolve, the following treatments can be used. Many women prefer to start with non-prescription or herbal remedies first. A common strategy is to use Vit E for a week, then add Dong Quai for a week. Though studies have shown them to be no more effective than placebo, if the hot flashes are relieved, then you have a solution. If not, then try Black Cohosh for a week. If the simultaneous use of all 3 does not help, then prescription medication from your physician will be needed. If the addition of Black Cohosh seems to help, eliminate the others, adding them back only if the effectiveness diminishes. It is appropriate to seek relief from any and all side effects of cancer treatment. Your quality of life is important. If your hot flashes bother you, do something about it! Vit E 400 to 800 units is said to reduce hot flashes. There are no known toxicities. A placebo controlled study, however did not show Vit E to be more effective than placebo, each reducing hot ßashes by 22-25% (Barton DL, et al. J Clin Oncol 1998;16:495-500). Dong Quai (from the root of Angelica sinensis) at a dose of 3 capsules 3 times daily (total dose 4500 mg/day) did not do better than placebo in relieving hot ßashes. (Hirata JD et al. Fertility and Sterility, 1997; 68(6):981-986) This herb is often combined with other herbs and used for other menopausal symptoms. Side effects may include a photosensitivity rash. Black cohosh root (Cimicifugae racemosae rhizoma, sold as Remifemin in Germany) was studied in Europe and was found to be effective in decreasing hot flashes (Lieberman S, Journal of Womenüs Health, 1998; 7(5):525-529). Dosage of the liquid extract is 40 drops twice a day. It is recommended that it be used for no more than 6 months. Rx Megestrol acetate (Megace), 20 mg twice a day works. In a placebo-controlled trial of 132 men and women, 74% of patients had a decrease of 50% or more compared to 20% with placebo. Side effects can be withdrawal bleeding (like menses) when the drug is stopped. One third of the women who tried megestrol chose to continue it for at least 3 years. Many were able to reduce the dose to as low as 20 mg every two days. Side effects can include weight gain (half gained less than 10 pounds, half gained from 10-20 pounds), vaginal bleeding, episodes of chills (rather than hot ßashes) and carpel tunnel syndrome. (Note, all these resolved when drug was stopped.) (Lobrinzi CL, et at. N Engl J Med 1994;331:347-352 and Quella SK, et al. Cancer 1998;82:1784-1788) Rx Oral Clonidine (Catapres), at a dose of.2-.4 mg twice daily, reduces hot ßashes by 46%. Used to treat hypertension, clonidineüs side effects can include nausea, fatigue, and dizziness. (Lauffer et al. Obstet Gynecol 1982;60:583-585) Clonidine also comes as a patch (applied once per week) which reduced the frequency of hot flashes from 80% to 36% compared with placebo. The patch has fewer side effects and does not lower blood pressure in people without hypertension. (Nagamani M, et al. Am J Obstet Gynecol 1987;156:561-565) Rx Venlafaxine (Effexor), 12.5 mg twice a day, on the average, reduces hot flashes from 6.6 to 4.3/day. Fifty percent of women had a decrease of 50% or more. (Loprinzi CL, et al. J Clin Oncol 1998;16:2377-2381) Rx Bellergal S-tabs (containing Ergotamine, phenobarital, and bellafoline) is often prescribed for hot flashes. I have been unable to find research evaluating its effectiveness. It is may be taken twice daily although it is more commonly used at bedtime to prevent night-time flashes. Side effects may be dry mouth and drowsiness. The above information comes from the following newsletters: The Integrative Medicine Consult 1999;1 (2):18 The Roxan Institute Palliative Care letter 1998;10 (3-4):5-6 Clinical Oncology Alert 1998;13(12):95-96 Additional sources include: Herbalgram, the Journal of the American Botanical Council. They are a reliable source of information on herbs and have a good selection of monographs and books available. phone (Texas) 512-926-4900 or www.herbalgram.org The Office of Dietary Supplements at the National Institutes of Health (NIH) as a web site that is constantly being updated and should provide current information about herbal remedies. http://dietary-supplements.info.nih.gov rev 2.26.99

copyright William M. Buchholz, M.D.

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