Veoza (Fezolinetant)

Overview 

What is Fezolinetant? 

Fezolinetant is a first-in-class, non-hormonal prescription medication developed by Astellas specifically to manage moderate-to-severe vasomotor symptoms (VMS) caused by menopause.

It is a highly selective neurokinin 3 (NK3) receptor antagonist. It represents a major therapeutic breakthrough by directly targeting the temperature control center (the hypothalamus) in the brain, offering an effective non-hormonal option for women seeking relief from menopausal hot flashes and night sweats. 

Global Names

Generic Name: Fezolinetant 
Brand Name: Veoza (Hong Kong, Europe), Veozah (US) 

Usage

What is Fezolinetant used for?

Veoza is indicated for the treatment of moderate to severe vasomotor symptoms (VMS) associated with menopause (commonly known as hot flashes and night sweats).

How do you use Fezolinetant?

Dosage: 45 mg once daily. No dose titration is required.

Routine: Take your tablet at about the same time each day, with or without food. 

Contraindications

• CYP1A2 Inhibitors: Concomitant use of moderate or strong CYP1A2 inhibitors (e.g., fluvoxamine, ethinyl estradiol-containing contraceptives, mexiletine, enoxacin), as they significantly increase Veoza levels in the blood and raise the risk of toxicity and liver injury.
• Pregnancy: Known or suspected pregnancy. Perimenopausal women of childbearing potential should use effective non-hormonal contraception. 

Precautions

• Liver Disease & Impairment: Veoza is not recommended for individuals with moderate (Child-Pugh Class B) or severe (Child-Pugh Class C) chronic hepatic impairment, or those with active liver disease. No dose modification is required for mild hepatic impairment (Child-Pugh Class A).

• Renal Impairment: Veoza is not recommended for individuals with severe renal impairment (eGFR <30 mL/min/1.73 m²) or end-stage renal disease (eGFR<15mL/min/1.73 m2) due to a lack of long-term safety data. No dose modification is required for mild-to-moderate renal impairment (eGFR  30 to <90mL/min/1.73 m²). 
  
  

Veoza Side Effects

Common Side Effects include: 

• Diarrhoea (3.2%)

• Insomnia (3.0%)

• Abdominal pain

• Elevated liver enzymes (ALT or AST increased)

Veoza Pharmacist Tips and Storage

Clinical Tips

• Before Starting: You must get a Liver Function Test (LFT) before initiating Veoza. Treatment cannot be started if your transaminases (ALT or AST ≥2×ULN) or total bilirubin are elevated. 

• First 3 Months: LFTs must be performed monthly during the first 3 months of treatment then at 6 and 9 months (per FDA & Hong Kong Department of Health Drug Office ) or periodically based on clinical judgement (per UK Medicines and Healthcare products Regulatory Agency (MHRA). 

Storage information

• Please store Veoza below 30^oC.

Availability of Veoza

Where is Veoza available in Hong Kong?

Veoza is a prescription medication available by prescription only and should be used under the guidance of a healthcare professional.

FAQs

Is Veoza a hormone replacement therapy (HRT)?

No. Veoza is entirely non-hormonal. It is a selective NK3 receptor antagonist that targets the temperature control center (KNDy neurons) in the brain directly to restore thermal balance, rather than replacing estrogen. This makes it an excellent option for women who cannot or choose not to take hormone therapies. Note that combining Veoza with estrogen-containing HRT is not recommended. 

How quickly will I feel relief from my hot flashes after starting Veoza? 

In the pooled analysis of the SKYLIGHT 1 and SKYLIGHT 2 studies, patients receiving Veoza experienced reductions in both the frequency and severity of vasomotor symptoms (VMS) as early as Week 1. By Weeks 4 and 12, Veoza demonstrated statistically significant and clinically meaningful reductions in the frequency and severity of moderate-to-severe hot flashes. These treatment benefits were maintained over long-term follow-up, with sustained improvement observed through 52 weeks. 

How effective is Veoza compared to a placebo?

Veoza is highly effective. According to pooled Phase 3 clinical data (SKYLIGHT 1 & 2): By Week 12, patients taking Veoza 45 mg experienced a 62.80% reduction in the frequency of moderate-to-severe hot flashes (compared to a 40.18% reduction in the placebo group).

What should I do if I miss a dose of Veoza?

If you miss a dose of Veoza, take it as soon as possible on the same day. If the next scheduled dose is less than 12 hours away, do not take the missed dose. Resume your regular dosing schedule on the following day.