Paroxetine (Seroxat) for hot flashes: a non-hormonal option

• What it is: paroxetine, a selective serotonin reuptake inhibitor (SSRI).
• Rx status: prescription only.
• Sold in PH: paroxetine HCl 20 mg (Seroxat), ₱68.75 per tablet (Watsons). Prices checked October 2026.
• Used for in menopause: moderate to severe hot flashes and night sweats, especially when HRT is not suitable. It may help mood at the same time.
• Not a hormone: it does not protect bones or help vaginal dryness.

About the dose: the 20 mg tablet at Watsons is the standard antidepressant strength. In the US, a low-dose paroxetine mesylate 7.5 mg capsule (Brisdelle) is approved specifically for moderate to severe hot flashes, taken once a day at bedtime (DailyMed label). We did not look for a low-dose product in the PH. Your doctor decides the dose; do not split or adjust tablets on your own.

Monthly cost examples are on the cost calculator.

Hot flashes come from the brain's temperature control centre, which becomes extra sensitive when estrogen drops. SSRIs act on serotonin, a brain chemical, and in trials low-dose paroxetine reduced how often and how strongly flashes came. Exactly how it works for hot flashes is not known: the US label for low-dose paroxetine says the mechanism is unknown.

The Menopause Society 2023 nonhormone position statement recommends SSRIs and SNRIs, along with CBT, clinical hypnosis, gabapentin, fezolinetant, oxybutynin and weight loss (Contemporary OB/GYN). The same statement does not recommend herbal remedies or soy.

Paroxetine is a good fit to discuss if you:

• Had breast cancer or a blood clot and were told to avoid hormones
• Prefer not to take hormones
• Have hot flashes together with low mood or anxiety

Hormone therapy is still the most effective option for hot flashes (The Menopause Society 2022). Paroxetine is a solid second line, not a lesser choice for women who need it.

• Tamoxifen users: paroxetine can block the liver enzyme that turns tamoxifen into its active form, which may make tamoxifen less effective. The UK label says to avoid paroxetine during tamoxifen treatment whenever possible. Women on tamoxifen are usually offered a different option.
• Other medicines: do not combine with MAOI antidepressants, and tell your doctor about any other antidepressant, migraine medicine (triptans), blood thinner, painkillers such as aspirin or ibuprofen, or tramadol. Combining paroxetine with other serotonin medicines can cause serotonin syndrome, and with blood thinners it raises bleeding risk (UK and US labels).
• Bipolar disorder or past mania, epilepsy or seizures, glaucoma, or pregnancy: your doctor needs to know. The labels advise caution with all of these, and the low-dose US product is not for use in pregnancy.

The UK label lists nausea and sexual problems (such as lower sex drive) as very common, and sleepiness or trouble sleeping, dizziness, headache, dry mouth, sweating, constipation or diarrhoea and weight gain as common. In the low-dose hot flash trials, nausea mostly happened in the first 4 weeks.

Do not stop suddenly. Stopping paroxetine quickly can cause dizziness, irritability and "electric shock" feelings, so doctors taper the dose slowly over weeks or months (UK label). These symptoms usually start within a few days of stopping and often settle within two weeks, but can last longer.

See a doctor soon if you have new or worse thoughts of self-harm or suicide, especially in the first weeks or after a dose change. If you are in crisis, call the NCMH Crisis Hotline at 1553 (landline, free, 24/7), 0919-057-1553 (Smart/TNT) or 0917-899-8727 (Globe/TM), or go to the nearest emergency room.

Bring a week or two of your hot flash counter so your doctor can see how often flashes come. Then ask:

• Is hormone therapy an option for me, or is there a reason to avoid it?
• Is 20 mg the right starting point, or should we start lower?
• Do any of my current medicines interact with paroxetine?
• How long should we try it before deciding if it works?
• How do we stop it safely later?
• Could it help my mood and sleep as well?

• Gabapentin: another non-hormonal option, often taken at bedtime.
• Fezolinetant: a newer non-hormonal drug, not found in the PH yet.
• CBT for hot flashes and sleep, recommended by NICE 2024 and The Menopause Society 2023.
• Hormone therapy, if it is safe for you: see HRT for menopause.

See all options on non-hormonal treatments, and find a doctor to talk them through.