What you need to know about Vezoah - the new game-changing drug for hot flushes

On May 12th 2023, the FDA approved the new US-made drug Vezoah, or, under its generic name, fezolinetant. This oral tablet is the first treatment of its kind. Fezolinetant is used to treat vasomotor symptoms, also known as hot flushes or flashes (in the US), which are widely regarded as the most prominent symptom of menopause and perimenopause. Unlike HRT (hormone replacement therapy), fezolinetant is a non-hormonal treatment. 

So, how does it work? Without getting too technical, fezolinentant works by blocking a specific neuron receptor in the brain, preventing the brain from increasing body temperature in response to a signal. HRT, on the other hand, works by replacing the oestrogen that has been lost in perimenopause and menopause. Oestrogen acts to counterbalance these neurons - but when oestrogen declines, this counterbalance is lost and hot flushes are experienced as a result. HRT therefore replaces this oestrogen, which blocks the neuron itself, whereas fezolinetant blocks the neuron receptor responsible for hot flushes. Doesn’t it sound like a game changer for hot flushes / flashes??? This would have been so helpful for me as i was getting 20-30 hot flushes a day and more at night …for 3 years.

Fezolinetant constitutes an important stride towards improving the diversity of treatments available to menopausal and perimenopausal women. In particular, due to its non-hormonal quality, fezolinetant can be used to treat those who cannot take HRT or for whom HRT is contraindicated. Currently, the alternatives to HRT are limited. The arrival of Vezoah in the market means that an alternative treatment, and indeed a highly effective one, is now available to those not able to use HRT or those who do not wish to use HRT.

Women who have had breast cancer or ovarian cancer, or who have an increased risk of developing these cancers, may be prescribed fezolinetant as a non-hormonal alternative to HRT. Some women with a history of heart disease, heart attack, or stroke may also be unsuitable for HRT, but may be suitable to use fezolinetant. While oestrogen is generally regarded as being more effective in treating hot flushes, clinical trials for fezolinetant demonstrated an impressive level of efficacy - which is excellent news for those searching for a comparable alternative to HRT.

A small number of side effects were reported in clinical trials, including diarrhoea, abdominal pain and insomnia. However, these were not commonly reported by participants. A very small proportion of those taking fezolinetant (2.3%) experienced negative effects on the liver. Those prescribed fezolinetant should have blood tests pertaining to the liver done before starting and at regular intervals while using the medication. However, it is important to note that the liver returned to normal once use of the drug ceased, and so the impact of Vezoah on the liver should not be overstated. With that being said, those with liver or kidney issues should not use it. 

So far, this all seems like great news. What’s the catch? The price, unfortunately. Vezoah’s price point is considerably steep at $550 for a 1-month supply. Cost may well act as a barrier to treatment for many. The average cost of a HRT prescription per month in Ireland is between €25 and €75, depending on the type and combination of hormones prescribed and the method of administration (transdermal or oral). As of now, late May 2023, there is no release date for Vezoah in Ireland. More information, including information about price, will be available once the drug is ready to be prescribed in Ireland.