Elinzanetant for Hot Flashes: What the Label Says Before You Start

If hot flashes and night sweats are wrecking your days and nights, and hormone therapy isn’t right for you, your clinician may mention elinzanetant. It was first approved in the U.S. in 2025 for moderate to severe hot flashes due to menopause.¹ It works on brain signals involved in temperature control, blocking two receptors called NK1 and NK3.¹ Here is what the label says.

How it’s taken

The dose is 120 mg, two 60 mg capsules, once a day at bedtime. Swallow the capsules whole.¹ Some other medicines require a lower dose or can’t be taken with it (see below).

Tests before and during

The label calls for:

• Liver blood tests before starting. It shouldn’t be started if certain liver values are two times the upper limit of normal or higher.¹
• Repeat liver tests about 3 months in. Stop it right away and contact your clinician if you have signs of liver injury.¹

Our article on fezolinetant, another nonhormonal hot flash medicine, covers its liver monitoring too.

Drowsiness and driving

In the main trials, nervous system effects such as sleepiness, tiredness, dizziness and feeling faint occurred in 11.9% of people on elinzanetant compared with 3.5% on placebo. The label advises not driving or doing hazardous tasks until these effects pass.¹ That’s one reason it’s taken at bedtime.

Seizure caution

In August 2026, the label added a warning: seizures have been reported in people taking it. It advises caution for people with a history of seizures or conditions that lower the seizure threshold.¹ Tell your clinician about any seizure history and medicines that affect it.

Drug and food interactions

• Avoid strong CYP3A4 inhibitors and grapefruit or grapefruit juice.¹
• Lower dose (one capsule) with moderate CYP3A4 inhibitors.¹
• Avoid medicines that strongly or moderately speed up CYP3A4.¹

Ask your pharmacist to check every medicine and supplement you take.

Other side effects

In a year-long trial, side effects more common than with placebo included headache, fatigue, dizziness, sleepiness, belly pain, rash, diarrhea and muscle spasms.¹

Not for pregnancy

The label says it must not be used during pregnancy.¹ If you’re in perimenopause and could still become pregnant, discuss contraception.

Questions to ask

1. Is hormone therapy an option for me, or is a nonhormonal medicine a better fit?
2. When will my liver be checked, and what symptoms should I watch for?
3. Do any of my medicines interact, including antifungals and antibiotics?
4. How will we decide if it’s working?
5. What will my plan cover?

Our guide to hot flash help without hormones covers other options.

Try: “My hot flashes wake me up every night and I’d rather not take hormones. Would elinzanetant be safe with my medicines and liver tests, and how would we monitor it?”

My Body Changed. Now What? includes a Visit Brief. Use it to list your hot flash pattern, medicines and health history for your appointment. See the book.