47 VOLUME 1, NUMBER 1 ■ MAY/JUNE 2003 www.SupportiveOncology.net A J Support Oncol 2003;1:47–51 © 2003 BioLink Communications O RIGINAL RESEARCH Pilot Evaluation of Citalopram for the Relief of Hot Flashes Debra L. Barton, RN, PhD, AOCN, Charles L. Loprinzi, MD, Paul Novotny, MS, Tait Shanafelt, MD, Jeff Sloan, PhD, Dietlind Wahner-Roedler, MD, Teresa A. Rummans, MD, Bradley Christensen, Shaker R. Dakhill, MD, and Laura S. Martin, RN This work was supported by a Komen Foundation grant. Correspondence to: Charles L. Loprinzi, MD, Division of Med- ical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; telephone: (507) 284-3731; fax: (507) 538-0823; e-mail: cloprinzi@ mayo.edu Abstract Symptoms associated with premature menopause are a sig- nificant problem for women with a history of breast cancer who cannot take hormone replacement therapy. Thus, effective nonhormonal alter- natives are needed to manage hot flashes, the most prevalent symptom of menopause. Previous studies have defined that venlafaxine, an anti- depressant, is an effective treatment for such hot flashes. Based on sug- gestive anecdotal information, we set out to evaluate, in a pilot trial, whether the antidepressant citalopram might be a good nonhormonal treatment option to add to our armamentarium for controlling hot flash- es. A prospective pilot study was developed in which patients were stud- ied for 5 weeks, with the first week used to establish a baseline, followed by 4 weeks of treatment with citalopram. During the first week of treat- ment, 10 mg/day of citalopram was taken while 20 mg/day was taken during each of the following three weeks. Hot-flash diaries were com- pleted daily, symptom diaries and quality-of-life items were completed weekly and the Profile of Mood States was completed at baseline and at week 5. Evaluable patients who completed the study had a mean hot- flash frequency reduction of 58% and a mean hot-flash score reduction of 64% from baseline to week 5. The patients finishing the study also reported decreased anger, tension and depression, as well as improved mood. This pilot trial suggests that citalopram may be an effective non- hormonal treatment for hot flashes in women who can tolerate it. lthough menopause, and the symptoms ac- companying it, are expected events in a woman’s life, this event can be riddled with psychological and physiological trauma. It four-arm, randomized, double-blind, placebo- controlled trial demonstrated that venlafaxine 75 mg/day reduced the incidence of hot flashes by about 60% [10]. Side effects from this treat- ment, which generally were tolerable in most women, included dry mouth, nausea/vomiting, and appetite loss [10]. Another antidepressant that has been studied for such treatment is flu- oxetine (Prozac). Results from a double-blind, placebo-controlled, cross-over clinical trial in- dicate that this antidepressant, too, decreases the incidence of hot flashes [12]. Unfortunately, neither of these antidepressants is effective for everyone and both have toxicities that limit their use [11, 12]. Some antidepressants may also have significant interaction with hepatic has been demonstrated that women who have been treated for breast cancer can experience prema- ture menopause with more frequent, distressing, and severe hot flashes than their peers experienc- ing natural menopause [1]. T hough not life threat- ening, hot flashes can significantly impact a wom- an’s sexuality, self-image, and function [2–4]. In addition, the severity of hot flashes is associated with decreased physical and emotional quality of life [2–5]. Estrogens and progestational agents are the most effective agents for reducing the incidence and severity of hot flashes, and can reduce their incidence by as much as 80% [2, 6, 7]. However, the results of the Women’s Health Initiative study suggest that combined conjugated estrogen and progesterone therapy cannot be recommended to most women at this time, and there is even more concern about giving estrogen and/or progester- one to women who have had breast cancer [8]. Most experts believe hormone therapy should not be prescribed for breast cancer survivors until there is evidence from large, prospective, randomized trials that proves it to be safe [9]. Therefore, at the present time, the most effective treatments for hot flashes cannot be recommended for women with a history of breast cancer. One of the most effective nonhormonal op- tions for preventing hot flashes to date is the antidepressant, venlafaxine (Effexor) [10]. A Drs. Barton, Loprinzi, Shanafelt, Sloan, Wahner-Roedler, and Rummans and Messrs. Novotny and Christen- sen are from the Mayo Clinic, Rochester, Minnesota. Dr. Dakhill is from the Wichita Community Clinical Oncology Program, Wichita, Kansas. Ms. Martin is from the McAuley Cancer Care Center, Ann Arbor, Michigan.