Veozah (fezolinetant) 45 mg once daily reduces moderate-to-severe hot flashes by roughly 60–65%, with separation from placebo as early as week one and benefit sustained through 52 weeks in the SKYLIGHT program. It contains no hormone at all — it blocks the neurokinin 3 receptor in the hypothalamus — so it is usable after breast cancer and with clotting risk. It requires liver enzyme testing at baseline and periodically thereafter, and it is expensive without insurance coverage.
How it works
Fezolinetant is the first hot flash drug designed backwards from the mechanism. When estradiol falls, hypothalamic KNDy neurons over-signal through neurokinin B, narrowing the thermoneutral zone and making trivial temperature rises trigger a full heat-dumping response. Fezolinetant occupies the NK3 receptor those neurons signal through — the flash pathway is interrupted upstream, with no estrogen exposure anywhere in the body.
Read the underlying physiology in what causes hot flashes.
What the SKYLIGHT trials showed
- Frequency. About 2.4 fewer moderate-to-severe episodes per day than placebo at week 12 on the 45 mg dose.
- Speed. Statistically significant separation from placebo at week one — the fastest onset of any option in our comparison table.
- Durability. Benefit maintained through 52 weeks in the extension.
- Sleep. Improved sleep-disturbance measures, consistent with fewer nocturnal episodes.
See it ranked against all 14 options →
Safety and monitoring — read this part
Post-marketing reports of serious liver injury led to a boxed warning. That does not make the drug unusable; it makes monitoring non-optional. Practically:
- Liver function tests before the first dose.
- Repeat testing on the schedule in current labeling during early treatment.
- Stop and call your clinician for jaundice, dark urine, pale stools, right-upper-quadrant pain, or new nausea with fatigue.
- Avoid entirely with cirrhosis, severe renal impairment, or strong CYP1A2 inhibitors.
Any telehealth service that will prescribe this without ordering labs is not practicing to the label. Our standards are on the clinical governance page, and unexpected reactions can be reported confidentially here.
Who it fits best
Women with moderate-to-severe symptoms who have a history of estrogen-sensitive breast cancer, prior VTE or thrombophilia, or who simply do not want hormones — and who have normal liver function and can complete monitoring. If none of those apply, estradiol remains more effective and far cheaper. If cost is the barrier, the older non-hormonal prescriptions are generic and effective.
Kindr does not promote any single product. We prescribe from the evidence and tell you when a cheaper option is equally appropriate — see how our plans work.
Kindr Health clinicians are licensed in all 50 states and prescribe guideline-concordant hot flash treatment — hormonal or hormone-free — with follow-up built into the plan.
Start your visit →Frequently asked questions
How well does Veozah work for hot flashes?
In SKYLIGHT 1 and 2, fezolinetant 45 mg reduced moderate-to-severe hot flash frequency by about 60-65% from baseline at week 12 — roughly 2.4 fewer episodes per day than placebo — with statistically significant separation from placebo by week one and benefit maintained to 52 weeks.
Is Veozah a hormone?
No. Fezolinetant is a small-molecule neurokinin 3 receptor antagonist. It does not bind estrogen receptors and does not raise estrogen levels, which is why it can be considered for women with a history of estrogen-receptor-positive breast cancer.
What blood tests does Veozah require?
Liver function tests before starting, then periodically during the first months of treatment per current labeling, because of hepatotoxicity signals including a boxed warning added after post-marketing reports of liver injury. Stop the drug and contact your clinician for jaundice, dark urine, right upper quadrant pain, or unexplained fatigue and nausea.
Who should not take fezolinetant?
It is contraindicated in known cirrhosis, severe renal impairment, or with strong CYP1A2 inhibitors such as fluvoxamine or ciprofloxacin. It is not for premenopausal women or anyone who is pregnant or breastfeeding.
How much does Veozah cost?
US list price is roughly $550-650 for a 30-day supply. Coverage varies widely; many plans require documentation that hormone therapy is contraindicated or ineffective. Manufacturer copay assistance may reduce out-of-pocket cost for commercially insured patients.
Veozah vs estrogen — which is better?
Estradiol is more effective (75-90% reduction versus 60-65%) and far cheaper. Fezolinetant wins when estrogen is contraindicated or declined. Neither has been shown superior on quality-of-life endpoints in a direct head-to-head trial.
How is elinzanetant different?
Elinzanetant blocks both NK1 and NK3 receptors and in the OASIS trials improved sleep disturbance alongside vasomotor frequency. It is the second entrant in the same class and a reasonable alternative where available.
Sources
- Lederman S et al. SKYLIGHT 1: fezolinetant for vasomotor symptoms. Lancet 2023;401:1091.
- Johnson KA et al. SKYLIGHT 2. Obstet Gynecol 2023;141:737.
- FDA prescribing information, VEOZAH (fezolinetant), including hepatotoxicity boxed warning.
- Pinkerton JV et al. OASIS 1 and 2: elinzanetant. JAMA 2024;332:1343.
- The Menopause Society. 2023 Nonhormone Therapy Position Statement.
Continue in the hot flashes hub
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Related evidence, peptides, and clinical tools on the same topic.
- Hot flashes & night sweats: evidenceJournal
- Fezolinetant (non-hormonal)Medication
- EstradiolMedication
Educational content only — not a substitute for professional medical advice, diagnosis, or treatment. Reviewed by the Kindr Health clinical team · Last reviewed 2026-07-26.