Menopause & Midlife

Fezolinetant (Veozah) for Hot Flashes: How It Works, Side Effects and Liver Risk

By the Find Her Doctor editorial team · Updated November 1, 2026 · 5 min read

Fezolinetant, sold as Veozah, is a non-hormonal prescription pill approved by the FDA in 2023 for moderate to severe hot flashes and night sweats caused by menopause. It works by blocking a brain signal involved in temperature control. Because rare serious liver injury has been reported, you'll need liver blood tests before and during treatment.

The Menopause Society's 2023 nonhormone position statement lists fezolinetant among the recommended non-hormonal options for hot flashes. If you've been told you can't take estrogen, or you just don't want to, this is one of the questions to bring to your next visit.

How does fezolinetant work?

Hot flashes start in the hypothalamus, the part of your brain that works like a thermostat. Certain nerve cells there, called KNDy neurons, are normally kept in check by estrogen. When estrogen drops at menopause, these neurons get overactive and signal through the neurokinin 3 (NK3) receptor. The brain then misreads normal body temperature as "too hot" and sets off sweating and flushing to cool you down. That's the 3 a.m. wake-up, soaked sheets, kicking off the blanket.

Fezolinetant is an NK3 receptor antagonist. It blocks that signal and helps reset the thermostat. That's a different approach from hormone therapy, which replaces estrogen, and from antidepressants or gabapentin, whose effect on hot flashes is less targeted.

How well does it work?

In the clinical trials that led to FDA approval, people taking fezolinetant had fewer and less severe hot flashes than people on placebo. Many people notice improvement within the first week or a few weeks.

Be realistic about the comparison: hormone therapy is still considered the most effective treatment for hot flashes overall. Fezolinetant gives people who can't or would rather not take hormones a targeted option.

Is it right for you? A quick checklist

Fezolinetant may be worth discussing if you:

• Have moderate to severe hot flashes or night sweats from menopause
• Can't take estrogen because of a history of blood clots, stroke or certain cancers
• Prefer to avoid hormones
• Didn't get enough relief, or had side effects, from other non-hormonal medicines

It was studied in postmenopausal women. It isn't approved for perimenopausal symptoms, and it doesn't prevent pregnancy, so if you're still having periods, keep using contraception.

Breast cancer survivors often ask about it. Fezolinetant isn't a hormone, so it may be an option for some, but it wasn't specifically studied in people with a breast cancer history. Loop in your oncologist as well as your gynecologist.

Who shouldn't take it?

According to the FDA label, fezolinetant shouldn't be used if you:

• Have cirrhosis
• Have severe kidney impairment or end-stage kidney disease
• Take medicines that are strong or moderate CYP1A2 inhibitors (some antibiotics, antidepressants and other drugs affect how your body clears fezolinetant)

Give your clinician and pharmacist a full list of your medicines and supplements. A photo of every bottle on your phone is the easiest way to do this.

The liver warning, in plain language

In late 2024, the FDA added a boxed warning, its strongest kind, after rare cases of serious liver injury were reported in people taking fezolinetant.

What that means day to day:

• Your clinician will order liver blood tests before you start.
• You'll need repeat liver tests during the first months of treatment, on a schedule set by the FDA label. Your clinician will tell you when.
• Stop taking fezolinetant and call your clinician right away if you notice:
  • Yellowing of the skin or whites of the eyes
  • Dark urine or pale stools
  • Itching
  • Unusual tiredness, nausea, vomiting or loss of appetite
  • Pain in the upper right part of your belly

Most people on fezolinetant don't have liver problems. The monitoring is there to catch the rare problem early. The practical burden is a few extra blood draws, so it helps to pick a lab near work or home and book them when you fill the prescription.

Other side effects

Side effects reported in trials included:

• Abdominal pain
• Diarrhea
• Trouble sleeping
• Back pain
• Hot flash-like feelings
• Changes in liver tests

Tell your clinician if something is bothersome or doesn't go away.

How it compares

Is there anything else like it? Yes. In October 2025 the FDA approved elinzanetant (Lynkuet), which blocks both the NK1 and NK3 receptors. It's another non-hormonal prescription option for moderate to severe menopausal hot flashes. Ask your clinician which one fits your health history and your plan's formulary.

For the full picture, see our guide to non-hormonal treatment for hot flashes.

What fezolinetant doesn't do

Fezolinetant treats hot flashes only. It does not:

• Treat vaginal dryness or pain with sex (see genitourinary syndrome of menopause)
• Prevent bone loss or osteoporosis
• Prevent pregnancy

If you have several menopause symptoms, you may need more than one treatment.

Cost and insurance

Coverage varies by plan. Some plans require you to try other treatments first or need a prior authorization. If the pharmacy says it isn't covered, ask your clinician's office to submit the prior authorization; many people get it approved after showing they've tried or can't take other options. Ask your pharmacist what the out-of-pocket price is before you leave the counter.

Your first three months on fezolinetant

1. Baseline blood work. Liver tests before your first dose. If results are elevated, your clinician may choose a different treatment.
2. Medicine review. Your clinician or pharmacist checks for interacting drugs.
3. Starting treatment. Take it exactly as prescribed. If you miss a dose, ask your pharmacist what to do rather than doubling up.
4. Follow-up liver tests during the first months. Put the dates in your calendar the day you start.
5. Check-in visit. After several weeks, review how much your hot flashes have improved and whether side effects are manageable.

Keep a simple hot flash diary for a week before you start and again after a month: count episodes and rate how much they bother you. It turns "I think it's a little better?" into something you and your clinician can actually judge.

When to see a doctor

Talk to your clinician if:

• Hot flashes or night sweats are affecting sleep, work or quality of life
• You're interested in a non-hormonal prescription option
• You're taking fezolinetant and notice any sign of liver problems (call right away)
• You have new symptoms or side effects after starting

Don't start, stop or change a prescription medicine on your own.

Gynecologists, OB/GYNs and women's health nurse practitioners can prescribe and monitor fezolinetant. Search the directory to find one near you in New York City, Long Island or the Hudson Valley, or browse gynecologists in Westchester.

Frequently asked questions

Sources

• FDA — Veozah (fezolinetant) prescribing information and Drug Safety Communication
• The Menopause Society — 2023 Nonhormone Therapy Position Statement
• ACOG — Management of Menopausal Symptoms (Practice Bulletin 141)
• FDA — Lynkuet (elinzanetant) approval, October 2025

This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.