Fezolinetant (Veozah) is a nonhormonal medication labeled for the treatment of moderate to severe vasomotor symptoms of menopause.¹ It is a small-molecule neurokinin 3 receptor antagonist, blocking neurokinin B from binding to thermoregulatory neurons. This prevents a cascade of heat dysregulation.

Safety

The main safety concern with fezolinetant is its effect on liver function. It is contraindicated in people with cirrhosis, severe renal impairment, or end-stage renal disease.1 Fezolinetant may cause early transient liver function test elevations greater than three times the upper limit of normal in about 2% of patients; these elevations resolve with discontinuation. It is unknown whether these liver function test elevations are clinically important. Patients should have baseline liver function testing when starting treatment with fezolinetant, and again at three, six, and nine months. Testing should be repeated if any symptoms of drug-induced liver injury develop. Fezolinetant should be discontinued if transaminase levels are twice the upper limit of normal at baseline or later rise to three times the upper limit of normal.¹