Verbatim response from Perplexity
The best non-hormonal treatment for hot flashes is usually fezolinetant if you want a newer, FDA-approved nonhormonal option specifically designed for menopausal hot flashes; however, low-dose paroxetine (Brisdelle) is the only nonhormonal medication explicitly identified as FDA-approved in several major clinical summaries, and hormone therapy remains more effective overall.[8][5][2]
What “best” means depends on your situation:
- Fezolinetant (VEOZAH): a newer nonhormonal option that targets the brain’s temperature-regulation pathway and is intended for moderate to severe menopausal hot flashes.[15]
- Paroxetine (Brisdelle): the best-established FDA-approved nonhormonal medication for hot flashes, with mild to moderate benefit.[5][8][9]
- SSRIs/SNRIs such as venlafaxine, desvenlafaxine, escitalopram, citalopram, and duloxetine: consistently effective alternatives, with trials showing meaningful reductions in hot flashes.[1][3][13]
- Gabapentin: often helpful, especially if night sweats or sleep disruption are a major issue.[1][3][10]
- Oxybutynin: can be very effective, with studies showing large reductions in hot flash frequency, though side effects may limit use.[1]
If you want the single most practical answer, paroxetine is the most established first-choice nonhormonal prescription option, while fezolinetant is the newer specialist option that many clinicians now consider for moderate to severe symptoms.[5][15][8]
For mild hot flashes or as add-ons, non-drug measures can help: keeping cool, avoiding alcohol/caffeine/spicy foods, dressing in layers, and using relaxation or mind-body therapies such as CBT, meditation, or hypnosis.[8][4][6][7]
If you want, I can also rank the top 5 nonhormonal options by effectiveness, side effects, and cost.