1. How it works

• Veozah is a brand (trade) name for fezolinetant which may be used to treat moderate to severe vasomotor symptoms (VMS) associated with menopause.
• Veozah works by blocking neurokinin B (NKB) binding on the kisspeptin/neurokinin/dynorphin (KNDy) neuron (this neuron appears to mediate the negative feedback actions of estradiol and also regulates pulsatile LH secretion). Modulation of KNDy neurons helps to moderate neuronal activity in the temperature control center of the brain reducing the frequency and severity of hot flashes.
• Veozah belongs to the class of medicines known as selective neurokinin 3 (NK3) receptor antagonists.

2. Upsides

• May be used to relieve moderate to severe vasomotor symptoms (VMS) of menopause. VMS are intense feelings of heat ("hot flashes" or "hot flushes"), night sweats, and feelings of warmth in the face, neck, and chest that can occur frequently in women transitioning through menopause. These can have a considerable effect on a woman's comfort and sleep, leading to anxiety, irritability, loss of productivity, depression, and potentially disrupt daily activities and impacting overall quality of life.
• One single 45mg tablet is taken orally, once daily.
• May be taken with or without food. Take with liquids and swallow whole. Do not cut, crush, or chew tablets.
• No dosage adjustment is needed for individuals with mild to moderate kidney disease (eGFR >30 mL/min/1.73m²), but should not be used in people with severe kidney disease (eGFR < 30 mL/min/1.73m²).
• Does not appear to affect levels of sex hormones, such as follicle-stimulating hormone, testosterone, estrogen, and dehydroepiandrosterone sulfate, in menopausal women but does cause a transient decrease in LH at peak concentrations.
• Does not have any clinically relevant effect on the QT interval.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Abdominal pain, diarrhea, insomnia, back pain, hot flashes, and hepatic transaminase elevations are the most common side effects reported. Hepatic function should be evaluated before the initiation of treatment with liver function tests (LFTs).
• LFTs should be repeated at 3 months, 6 months, and 9 months after initiation of therapy and when symptoms (such as nausea, vomiting, or yellowing of the skin or eyes) suggest liver injury. Elevations in ALT and AST of greater than 3 times the upper limit of normal have been reported.
• Should not be used in women with known cirrhosis, severe renal impairment (eGFR 15 to < 30 mL/min/1.73m²) or end-stage renal disease, or who are taking CYP1A2 inhibitors, such as fluvoxamine, cimetidine, amiodarone, or norfloxacin (see the product information for a full list of interactions). Has not been studied in women with Child-Pugh Class C hepatic impairment but studies show an increased exposure in those with Child-Pugh Class A or B.
• There is no data on the use of Veozah in pregnant women or the presence of fezolinetant in human milk. Animal studies have not shown any effect on fertility.
• Not for use in women under the age of 18.
• Five cases of disordered proliferative endometrium with Veozah compared to 4 cases with placebo were reported across three clinical trials that also recorded one case of endometrial hyperplasia and one endometrial carcinoma with Veozah (none reported in the placebo groups).

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

• Veozah may be used to treat moderate to severe vasomotor symptoms of menopause such as hot flashes and night sweats. It is taken as an oral tablet, once daily but cannot be taken by women with cirrhosis, severe kidney disease, or who take certain medications such as fluvoxamine, mexiletine, or cimetidine.

5. Tips

• Take your Veozah tablet once daily, with or without food, at approximately the same time each day. Swallow it whole with liquid, do not crush or chew.
• If you miss a dose, take it as soon as you remember but if it is less than 12 hours before your next dose, miss that dose and return to your regular schedule the next day. Do not take two doses at once.
• Tell your doctor if you have ever had any problems with your kidneys or your liver before you start taking Veozah.
• You will need to have some blood tests to check your liver function before starting Veozah. These will need repeating after 3, 6, and 9 months of use. Make sure you keep your scheduled appointments for your blood tests.
• Tell your doctor if you experience any serious or unusual side effects such as nausea, vomiting, or yellowing of the skin or eyes.
• Side effects such as abdominal pain, diarrhea, insomnia, back pain, or hot flushes are common with Veozah but talk to your doctor if these become troublesome.
• Tell your doctor about all the medications or supplements that you take, including those purchased from a drug store, gas station, or pharmacy, before you start taking Veozah, because some may not be compatible.

6. Response and effectiveness

• Steady-state concentrations are reached within 2 days (2 doses) with minimal accumulation.
• The time to reach peak concentrations is 1.5 (1 to 4) hours in healthy women.
• Food, even a high-calorie, high-fat meal, has no significant effects on the pharmacokinetics of Veozah.
• The half-life of fezolinetant is 9.6 hours in women with vasomotor symptoms.
• Veozah decreased the frequency of vasomotor symptoms over 24 hours by 2.6 (95% CI -3.4 to -1.7; p < 0.001) in one trial and by 7.5 (95% CI -3.6 to -1.5; p < 0.001) in the second compared with placebo (an inactive treatment). It also decreased the severity of events by 0.2 (95% CI -0.4 to -0.1; p < 0.007) in one trial and 0.3 (95% CI -0.5 to -0.1; p < 0.001) in the second trial, compared to placebo.

7. Interactions

Medicines that interact with Veozah may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with Veozah. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Veozah include:

• CYP1A2 inhibitors, such as fluvoxamine, cimetidine, amiodarone, mexiletine, or norfloxacin (see the product information for a full list of interactions). Veozah is a substrate of CYP1A2 and concentrations of Veozah can increase when used with medicines that are weak, moderate, or strong inhibitors of CYP1A2.

Note that this list is not all-inclusive and includes only common medications that may interact with Veozah. You should refer to the prescribing information for Veozah for a complete list of interactions.