The short answer
Effective non-hormonal options include fezolinetant (Veozah), elinzanetant (Lynkuet), certain SSRIs and SNRIs, and gabapentin. Each is metabolized differently, so the right choice depends partly on your ART. Gabapentin has essentially no metabolic interactions with ART; elinzanetant should be avoided with strong CYP3A inhibitors such as ritonavir and cobicistat; fezolinetant requires liver monitoring. A clinician checks your exact regimen before prescribing.
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When non-hormonal treatment may be preferred
- A history of breast cancer, or other reasons hormone therapy is not advised.
- A history of blood clots or stroke where hormones are not recommended.
- Personal preference to avoid hormones.
- Symptoms that persist on hormone therapy, where a non-hormonal medicine is added.
- Low mood or anxiety alongside hot flashes, where an SSRI or SNRI may help both.
Fezolinetant (Veozah)
Fezolinetant is an FDA-approved neurokinin 3 (NK3) receptor antagonist for moderate to severe hot flashes due to menopause. It acts on the brain’s temperature-control center rather than on hormones.
Its label carries a boxed warning for serious liver injury. Liver blood tests are needed before starting and regularly during the first months. That is especially relevant for women with hepatitis B or C coinfection, raised liver enzymes, or other medicines that affect the liver.
Fezolinetant is broken down mainly by the CYP1A2 enzyme and must not be used with CYP1A2 inhibitors. Most antiretrovirals are not CYP1A2 inhibitors, but some boosted regimens may induce CYP1A2 and lower fezolinetant levels, so an interaction check is still needed.
Elinzanetant (Lynkuet)
Elinzanetant is an FDA-approved dual neurokinin 1 and 3 (NK1/NK3) receptor antagonist for moderate to severe hot flashes due to menopause. Trials also showed improvements in sleep disturbance.
Elinzanetant is broken down mainly by CYP3A4. Its label advises avoiding use with strong CYP3A inhibitors and with moderate or strong CYP3A inducers. Ritonavir and cobicistat are strong CYP3A inhibitors, and efavirenz, etravirine and nevirapine are inducers. For women on boosted regimens or these NNRTIs, another option is usually chosen. With unboosted integrase inhibitor regimens, the interaction concern is much lower.
SSRIs and SNRIs
Low-dose paroxetine mesylate (Brisdelle) is FDA-approved for hot flashes. Other SSRIs and SNRIs, such as venlafaxine, desvenlafaxine, escitalopram and citalopram, are used off-label and reduce hot flashes modestly.
Some interact with boosted regimens: ritonavir and cobicistat can raise or lower levels of certain antidepressants. Citalopram and escitalopram have heart-rhythm considerations alongside some ART. Paroxetine strongly inhibits CYP2D6 and can interact with other medicines. Your clinician picks the agent and dose with your full medicine list in view.
Gabapentin and other options
Gabapentin reduces hot flashes, particularly at night, and is used off-label. It is cleared by the kidneys and not by liver enzymes, so it has no metabolic interactions with ART. Drowsiness and dizziness are common, and doses are adjusted for kidney function.
Clonidine and oxybutynin also reduce hot flashes in studies but have more side effects and are used less often. Cognitive behavioral therapy and clinical hypnosis have evidence for reducing how bothersome hot flashes feel.
Interaction profiles at a glance
| Medicine | Main metabolism | With boosted PIs or cobicistat | With efavirenz, nevirapine or etravirine | With unboosted INSTIs |
|---|---|---|---|---|
| Fezolinetant (Veozah) | CYP1A2 | Possible lower levels; check | Check | No significant interaction expected |
| Elinzanetant (Lynkuet) | CYP3A4 | Avoid per label (strong CYP3A inhibitors) | Avoid per label (inducers) | No significant interaction expected |
| Paroxetine | CYP2D6 | Levels may change; check | Check | No significant interaction expected |
| Venlafaxine / desvenlafaxine | CYP2D6, CYP3A4 / mostly conjugation | Check | Check | No significant interaction expected |
| Gabapentin | Kidneys (not metabolized) | No metabolic interaction | No metabolic interaction | No metabolic interaction |
Vaginal and urinary symptoms
Non-hormonal vaginal moisturizers and lubricants help dryness and discomfort. Low-dose vaginal estrogen is very effective and minimally absorbed, so it is often appropriate even for women avoiding systemic hormones; your clinician confirms this for your history. Prasterone (Intrarosa) and ospemifene (Osphena) are other approved options.
Specialized care pathway
Menopause care that works alongside your HIV care
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Questions, answered
Common questions
Can I take Veozah with HIV medication?
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Often yes, after an interaction check. Fezolinetant is metabolized by CYP1A2, which most ART does not inhibit, but liver monitoring is required because of its boxed warning for liver injury.
Can I take Lynkuet if I am on a boosted regimen?
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Elinzanetant’s label advises avoiding strong CYP3A inhibitors, which include ritonavir and cobicistat, and CYP3A inducers such as efavirenz. A different option is usually chosen with those regimens.
Which non-hormonal option has the fewest interactions with ART?
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Gabapentin is not metabolized by liver enzymes and has no metabolic interactions with ART, though it can cause drowsiness. The best option still depends on your symptoms and health.
Do antidepressants help hot flashes?
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Some SSRIs and SNRIs reduce hot flashes modestly, and low-dose paroxetine is FDA-approved for this. They can be a good choice when mood symptoms are also present.
Are non-hormonal options as effective as HRT?
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Hormone therapy is generally the most effective treatment for hot flashes. NK receptor antagonists have shown substantial reductions in trials, and SSRIs, SNRIs and gabapentin have smaller effects.
WRITTEN & MEDICALLY REVIEWED BY
Kindr Health Clinical Team
Kindr Health Inc. — Editorial & Clinical Team, led by Kevin Wolfe, CMO
Kindr’s clinical content is written and reviewed by board-certified clinicians who prescribe hormone therapy every day across all 50 states — menopause-focused physicians, nurse practitioners, and pharmacists working under Kindr Health, Inc.’s organizational clinical oversight. Every page is checked against current NAMS and ACOG guidance, FDA labeling, and the primary literature before publication, then re-reviewed on a rolling schedule when guidance changes.
Organizational NPI 1609792902 · Last reviewed October 4, 2026 · Editorial policy
Educational content only — not a substitute for individual medical advice, diagnosis, or treatment.
SOURCES & REFERENCES
Every clinical claim on this page is sourced.
- VEOZAH (fezolinetant) prescribing information — DailyMed, U.S. National Library of Medicine. dailymed.nlm.nih.gov/dailymed/search.cfm?query=fezolinetant
- LYNKUET (elinzanetant) prescribing information — DailyMed, U.S. National Library of Medicine. dailymed.nlm.nih.gov/dailymed/search.cfm?query=elinzanetant
- HIV Drug Interactions Checker — University of Liverpool. www.hiv-druginteractions.org/checker
- The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society (2023) — Menopause (journal of The Menopause Society). pubmed.ncbi.nlm.nih.gov/?term=2023+nonhormone+therapy+position+statement+North+American+Menopause+Society
- Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV: Women with HIV — U.S. Department of Health and Human Services (DHHS), Clinicalinfo.HIV.gov. clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/women-hiv
- EACS Guidelines (drug-drug interactions, menopause, bone and cardiovascular sections) — European AIDS Clinical Society. www.eacsociety.org/guidelines/eacs-guidelines