Veozah (fezolinetant) review: the non-hormonal hot flash option that actually has FDA approval

What Veozah is, and what makes it different

Veozah, or fezolinetant, is a prescription pill approved by the FDA in May 2023. It treats moderate to severe hot flashes and night sweats caused by menopause. Doctors call these vasomotor symptoms. Astellas Pharma makes it. You take one 45 mg tablet a day.

What makes it different is how it works. Veozah blocks a brain receptor called neurokinin 3, or NK3. That receptor sits in the hypothalamus, the brain's thermostat. A messenger called neurokinin B acts on it, and its misfiring drives hot flashes. Veozah contains no estrogen, progesterone or any other hormone. That matters. Women who cannot or would rather not use hormone therapy now have an FDA-approved option backed by trials.

Does Veozah work? What the SKYLIGHT trials showed

Veozah was tested in the SKYLIGHT program. These large phase 3 trials compared it with a placebo, a dummy pill. SKYLIGHT 1 and 2 together enrolled over 1,000 women with moderate to severe hot flashes. The key findings:

• Hot flashes came less often than on placebo at weeks 4 and 12. The gap was statistically significant.
• Hot flashes were also milder than on placebo
• Improvement showed up within the first week
• The benefit held through 52 weeks in the longer follow-up
• Side effects were about as common as on placebo in the first 12 weeks

Statistically significant means the gain is very unlikely to be chance. It does not mean every woman responded. In a pooled analysis of both trials, 59% of women on Veozah cut their hot flashes by half or more by week 12. On placebo, 36% did. The placebo number is high, which is common in hot flash studies. The gap between the two is what Veozah adds.

Is Veozah safe? The boxed warning for liver injury

This is the most important thing to understand before you start. The FDA added a boxed warning, its strongest safety label, for rare but serious liver injury. It came in December 2024. It followed a report of serious liver injury in a woman after about 40 days on the drug.

In practice, here is what the current label asks:

• Before you start: a liver blood test. You should not start if some liver values are already twice the normal limit or higher.
• While you take it: the same test every month for the first three months, then again at months 6 and 9.
• Who cannot take it: anyone with cirrhosis, even its mildest form. The same goes for severe kidney disease or kidney failure.
• Medicines that rule it out: drugs that block CYP1A2, a liver enzyme that clears Veozah. One example is the antidepressant fluvoxamine.
• Warning signs: new tiredness, less appetite, nausea, vomiting, itching, yellow skin or eyes, pale stools, dark urine or belly pain. If they appear, stop the drug and contact your provider right away.

This is a real safety issue, not a legal formality. For women with normal liver tests at the start, the risk is low. It is not zero. Your full medicine list matters too, because some drugs raise Veozah levels in the blood.

Who Veozah actually makes sense for

The clearest use is a woman with moderate to severe hot flashes who cannot use hormone therapy, or would rather not. That includes:

• Women with a history of hormone receptor-positive breast cancer, who usually cannot take hormones. The SKYLIGHT trials left out women with a cancer history, so data in this group is limited. Ask your oncologist about it specifically.
• Women with a personal or family history of blood clots in the legs or lungs, which makes estrogen therapy riskier
• Women who tried hormone therapy and could not tolerate the side effects
• Women who prefer a non-hormonal approach for any reason

If you can use hormone therapy, it usually does more overall. It treats hot flashes. It also helps protect bone and eases vaginal dryness. Veozah is a tool for one symptom. It does not replace the wider effects of hormones.

How much does Veozah cost?

What you pay depends mostly on your insurance. Here is the quick answer:

• With commercial insurance: about $30 a month with the Astellas savings card. The first month is free. Commercial insurance means a plan through work or one you buy yourself.
• Paying cash with a free coupon: about $465–$490 a month at the big chains, through GoodRx or SingleCare. Walmart is usually the cheapest.
• Paying cash with no coupon: about $780 a month at the pharmacy counter.
• On Medicare: the savings card does not apply. Part D coverage varies by plan, so check your plan's drug list before you start.

The savings card pays up to $4,000 a year. It does not work with Medicare, Medicaid, TRICARE, VA or any other government plan. Veozah's list price is about $585 a month. That is the maker's price to wholesalers, not what you pay at the counter.

Most commercial plans cover Veozah in some way. Astellas reports that about 88% of commercially insured people had coverage as of December 2025. That figure leaves out marketplace plans. Much of this coverage needs prior authorization, meaning the plan must approve the drug before it pays. Some plans also want proof that you tried another treatment first. For the full breakdown of cash, coupons, the savings card and Medicare, see Veozah's real price, unpacked.

How to get a Veozah prescription

Veozah needs a prescription. An OB-GYN, a primary care doctor or any clinician licensed to prescribe in your state can write it. Menopause telehealth services can help too. Midi Health builds care plans that include non-hormonal options. If you and your clinician lean toward hormones instead, Alloy is built around hormone therapy.

Before prescribing, your clinician should order your liver tests. They should also review your current medicines and your history, especially any liver disease. The prescription can then go to any retail or mail-order pharmacy.

What Veozah does not do

Be clear about its limits. Veozah is approved only for hot flashes and night sweats. It does not prevent bone loss. It does not treat vaginal dryness or the other genital and urinary changes of menopause, called GSM. It does not improve sleep, beyond fewer night sweats waking you. It does not treat mood changes. If hot flashes are your main problem, it fits. For a complete menopause treatment, it is not the whole answer.