ce CONTINUING EDUCATION WOMEN’S HEALTH
contraindicated with concomitant CYP1A2 inhibitors.
How Supplied: Fezolinetant is available as a 45 mg film-coated tablet in bottles of 30 and 90. It should be stored at controlled room temperature and pro- tected from high humidity and moisture. Additional Notes: Fezolinetant is a hormone free option that can work in as little as one week. Patients may ask about over-the-counter supple- ments to help with hot flashes, such as black cohosh and phytoestrogens (i.e., soy). Advise them that there is limited evidence to support their efficacy, but if they choose to use them it should not be taken with fezolinetant. Other ways patients can control vasomotor symptoms associated with menopause include wearing cool layers and moisture-wicking fabrics and including physical activity in their daily routine. Zurzuvae (zuranolone) Indication and Mechanism of Action: Zuranolone is the first oral medication approved for the treatment of postpartum depression (PPD) in adult women. Zuranolone received both priority review and fast track status because of the clear unmet medical need; about 1 in 8 women report symptoms of PPD within the first year of giving birth and many cases go undiagnosed and untreated. Zuranolone was studied in a 6-week clinical trial of 195 women with PPD. Significant improvements were seen in PPD symptoms at day 15, and as early as day 3, compared to placebo.
Veozah (fezolinetant) Indication and Mechanism of Action: Fezolinetant is indicated to treat moderate to severe vasomotor symptoms associated with menopause. It received priority review in 2023, which means it under- went expedited review because it showed major advances in treatment where no treatment existed. Fezolinetant is an neurokinin-3 receptor antagonist that blocks neurokinin B (NKB) from binding on the kisspeptin/neurokinin B/dynorphin (KNDy) neuron to modulate neuronal activity in the thermoregulatory center. The results of three clinical studies show that fezolinetant decreased both frequency and severity of vasomotor symptoms compared to placebo. Administration: The dose of fezolinetant is 45 mg by mouth once daily, with or without food. Counsel patients to take with liquids and swallow whole; do not cut, crush, or chew. If a dose is missed, it should be taken as soon as possible if it is greater than 12 hours from the next dose. Otherwise, skip it. Do not take more than one dose at a time. Safety: The most commonly reported adverse events are abdominal pain, diarrhea, insomnia, back pain and hot flush. Fezolinetant is contraindicated in women with severe renal disease and known cir- rhosis. It can cause hepatic transaminase elevation; establish baseline liver function prior to initiation and test liver enzymes every 3 months during treatment or when symptoms indicate liver injury. Fezolinetant is a substrate of CYP1A2 so strong inhibitors can affect plasma concentrations, therefore, it is
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