Veozah for Hot Flashes: What to Know in 2026

Veozah is the brand name for fezolinetant, a small molecule made by Astellas. It is the first medication in a class called neurokinin 3 (NK3) receptor antagonists. The science behind it traces to a group of neurons in the hypothalamus called KNDy neurons, which use the neurotransmitter neurokinin B to signal through NK3 receptors. As estrogen falls in menopause, these neurons become hyperactive, which destabilizes the brain's temperature set point. Small temperature changes that the brain would normally ignore now trigger the cascade of vasodilation, sweating, and flushing we recognize as a hot flash. Fezolinetant blocks the NK3 receptor and quiets these neurons, restoring more normal temperature regulation without acting on estrogen receptors anywhere in the body.

The pivotal SKYLIGHT 1 and SKYLIGHT 2 trials enrolled women with moderate-to-severe vasomotor symptoms (averaging seven or more hot flashes per day at baseline). After 12 weeks, women on the 45 mg dose experienced about a 60% reduction in hot flash frequency and meaningful improvements in severity, compared with about 40% on placebo. Improvements were noted as early as week 1. The SKYLIGHT 4 long-term safety study followed women for 52 weeks and showed sustained benefits. Sleep quality also improved, likely because night sweats decreased.

Veozah is FDA-approved for moderate-to-severe vasomotor symptoms in postmenopausal women. It is especially useful for women who cannot take estrogen, including those with a history of breast cancer, estrogen-sensitive cancers, blood clots, stroke, or significant cardiovascular disease, and those who simply prefer to avoid hormones. It also fits women who are on tamoxifen or aromatase inhibitors and are experiencing significant hot flashes. Women with active liver disease, those taking strong CYP1A2 inhibitors (such as fluvoxamine or some quinolone antibiotics), and those with severe kidney disease are not appropriate candidates.

The most common side effects in trials were abdominal pain, diarrhea, insomnia, back pain, hot flashes (paradoxically reported in a small number), and elevated liver enzymes. The FDA later added a boxed warning about rare cases of serious liver injury identified in post-marketing reports. As a result, liver function tests are required before starting, monthly for the first three months, then at six and nine months. If symptoms of liver injury appear (yellowing of the skin or eyes, dark urine, severe fatigue, persistent nausea, or right-upper-abdomen pain), the medication must be stopped and the prescriber notified. With this monitoring, most patients can take Veozah safely.

Compared to off-label options like SSRIs (paroxetine is FDA-approved for hot flashes as Brisdelle, others are off-label), SNRIs like venlafaxine, gabapentin, and clonidine, Veozah was specifically designed for vasomotor symptoms and tends to be more effective with fewer central nervous system side effects. Lynkuet (elinzanetant), a newer dual NK1/NK3 antagonist from Bayer, was approved in late 2025 and may offer an even broader symptom benefit, including improvements in mood and sleep. Cost and access vary; some women try one and switch if the first does not work.

The list price is around $550 per month, similar to other branded menopause medications. With commercial insurance coverage, copays often fall to $25 to $50 per month, and Astellas offers a savings program that can reduce the copay to as low as $5 for eligible patients with commercial insurance. Medicare and Medicaid coverage is variable. Generic versions are not yet available since fezolinetant is patent-protected. Telehealth menopause clinics often have streamlined access, including the required liver-enzyme monitoring.

After your baseline liver function test is normal, you take one 45 mg tablet by mouth once daily, with or without food. Most women notice some reduction in hot flashes within the first two weeks, with maximum benefit by week 8 to 12. Sleep often improves as night sweats decrease. If you have not noticed meaningful improvement by 12 weeks, talk with your prescriber about whether to continue or switch. Long-term safety data through 52 weeks looks reassuring, but the medication is still relatively new, so ongoing follow-up matters.