For the treatment of moderate to severe Vasomotor Symptoms (VMS)—commonly referred to as hot flashes and night sweats—due to menopause1,2

STUDIED FOR
SAFETY AND
TOLERABILITY
for 1 YEAR

Woman in blue holding VEOZAH™ (fezolinetant) logo fire extinguisher
Woman in blue holding VEOZAH™ (fezolinetant) logo fire extinguisher

The safety of VEOZAH was evaluated in three 52-week clinical trials with 1100 women receiving VEOZAH1

ADVERSE REACTIONS IN TRIAL 3
(≥2% in VEOZAH 45 mg and > placebo)1*


ADVERSE REACTION

VEOZAH 45 mg (n=609)
Total person-years=504.2
n (%, EAIR)

PLACEBO (n=610)
Total person-years=475.0
n (%, EAIR)

Abdominal pain

26 (4.3%, 5.2)

13 (2.1%, 2.7)

Diarrhea

24 (3.9%, 4.8)

16 (2.6%, 3.4)

Insomnia

24 (3.9%, 4.8)

11 (1.8%, 2.3)

Back pain

18 (3.0%, 3.6)

13 (2.1%, 2.7)

Hot flush

15 (2.5%, 3.0)

10 (1.6%, 2.1)

Hepatic transaminase elevation


14
(2.3%, 2.8)


5
(0.8%, 1.1)

In the pooled laboratory data of Trials 1, 2, and 3, elevated hepatic transaminases (>3x the ULN) occurred in 25 women (2.3%, 2.7 EAIR) exposed to VEOZAH 45 mg (n=1100, 912.1 total person-years) as compared to 8 women (0.9%, 1.5 EAIR) exposed to placebo (n=952, 549.1 total person-years).1

EAIR=exposure-adjusted incidence rate, ULN=upper limit of normal.

*Measured as EAIR, meaning the number of individuals experiencing an adverse event divided by exposure time (total person-years) x 100.1

Abdominal pain (including abdominal pain, abdominal pain lower, abdominal pain upper).1

Hepatic transaminase elevations (including alanine aminotransferase [ALT] abnormal, ALT increased, aspartate aminotransferase [AST] abnormal, AST increased).1

Hepatotoxicity1


Liver icon

Clinical trials

In 3 clinical trials, elevations in serum ALT and/or AST >3x the ULN occurred in 2.3% of patients receiving VEOZAH (EAIR of 2.7 per 100 person-years) and 0.9% (EAIR of 1.5 per 100 person-years) of patients receiving placebo. No elevations in serum total bilirubin (>2x the ULN) occurred


  • Women with ALT or AST elevations were generally asymptomatic

  • Transaminase levels returned to pretreatment levels (or close to these) without sequelae with dose continuation, and upon dose interruption, or discontinuation

  • Women with cirrhosis were not studied

Lightbulb icon

Postmarketing experience

Cases of serious drug-induced hepatotoxicity occurred within 40 days of starting VEOZAH


  • Patients experienced elevated transaminases (up to 50x the ULN at peak elevation), elevated ALP (up to 4x the ULN at peak elevation), and bilirubin (up to 5x the ULN at peak elevation) coupled with symptoms of fatigue, nausea, pruritus, jaundice, pale feces, and dark urine

  • After discontinuation of VEOZAH, these abnormalities gradually resolved

Paper with magnifying glass icon

Hepatic laboratory testing and discontinuation criteria

  • Perform baseline hepatic laboratory tests to evaluate for hepatic function and injury [including serum ALT, serum AST, serum ALP, and serum bilirubin (total and direct)] prior to VEOZAH initiation. Do not start VEOZAH if ALT or AST is ≥2x the ULN or if the total bilirubin is ≥2x the ULN for the evaluating laboratory

  • Perform follow-up hepatic laboratory tests monthly for the first 3 months, at 6 months, and 9 months after initiation of therapy

  • Advise patients to discontinue VEOZAH immediately and seek medical attention including hepatic laboratory tests if they experience signs or symptoms that may suggest liver injury (new onset fatigue, decreased appetite, nausea, vomiting, pruritus, jaundice, pale feces, dark urine, or abdominal pain)

  • Discontinue VEOZAH if transaminase elevations are >5x the ULN, or if transaminase elevations are >3x the ULN and the total bilirubin level is >2x the ULN

  • If transaminase elevations >3x the ULN occur, perform more frequent follow-up hepatic laboratory tests until resolution

  • Exclude alternative causes of hepatic laboratory test elevations


ALP=alkaline phosphatase.

Effects on endometrium1


Endometrial safety icon

In patients receiving VEOZAH 45 mg across the Phase 3 studies:

  • Endometrial biopsy assessments identified 1 case of endometrial hyperplasia and 1 case of endometrial malignancy

  • The rate of these events was ≤1%, with the upper bound of the one-sided 95% confidence limit being ≤4%

  • Disordered proliferative endometrium was reported in 5 patients receiving VEOZAH 45 mg (EAIR of 1.4 per 100 person-years) and 4 patients receiving placebo (EAIR of 2.0 per 100 person-years)

Additional menopausal symptoms icon

Additional menopausal symptoms women commonly experience include weight gain, daytime sleepiness, and decreased libido3-5

Select safety data6-8



In a pooled analysis of Trials 1, 2, and 3*:

Less than 3% rate of discontinuation icon

Rate of discontinuation

<3% of patients taking VEOZAH 45 mg withdrew from study treatment due to VEOZAH-related treatment-emergent adverse events (2.8% vs 2.5% with placebo)

Less than 1% rate of of weight gain and somnolence icon

Rates of weight gain and somnolence

<1% of patients taking VEOZAH 45 mg experienced weight gain (0.7% vs 1.1% with placebo), similar to those who experienced somnolence (0.6% vs 0.6% with placebo)

In Trials 1 and 2, respectively:

Less than 2% rate of decreased libido

Rate of decreased libido

<2% of patients taking VEOZAH 45 mg experienced decreased libido (0.6% vs 0.0% with placebo; 1.2% vs 0.0% with placebo)

*Data from Trials 1, 2, and 3 were pooled for the 52-week analysis. Analyses were performed using the safety analysis set (SAS) (VEOZAH 45 mg n=1100, Placebo n=952). Frequency of treatment-emergent adverse events (TEAEs) was a prespecified endpoint.6‡

TEAEs reported in a 12-week period based on data collected from the SAS of Trials 1 (VEOZAH 45 mg n=173, Placebo n=175) and 2 (VEOZAH 45 mg n=167, Placebo n=167).8‡

The SAS comprised all randomized participants who took at least 1 dose of study treatment.6


Learn about VEOZAH dosing and administration



INDICATIONS AND USAGE

IMPORTANT SAFETY INFORMATION


VEOZAH™ (fezolinetant) is a neurokinin 3 (NK3) receptor antagonist indicated for the treatment of moderate to severe vasomotor symptoms due to menopause.

WARNING: RISKS OF HEPATOTOXICITY
Hepatotoxicity has occurred with the use of VEOZAH in the postmarketing setting.

  • Perform hepatic laboratory tests prior to initiation of treatment to evaluate for hepatic function and injury. Do not start VEOZAH if either aminotransferase is ≥ 2x the upper limit of normal (ULN) or if the total bilirubin is ≥ 2x ULN for the evaluating laboratory.
  • Perform follow-up hepatic laboratory testing monthly for the first 3 months, at 6 months, and 9 months of treatment.
  • Advise patients to discontinue VEOZAH immediately and seek medical attention including hepatic laboratory tests if they experience signs or symptoms that may suggest liver injury (new onset fatigue, decreased appetite, nausea, vomiting, pruritus, jaundice, pale feces, dark urine, or abdominal pain).
  • Discontinue VEOZAH if transaminase elevations are > 5x ULN, or if transaminase elevations are > 3x ULN and the total bilirubin level is > 2x ULN.
  • If transaminase elevations > 3x ULN occur, perform more frequent follow-up hepatic laboratory tests until resolution.

INDICATIONS AND USAGE
VEOZAH™ (fezolinetant) is a neurokinin 3 (NK3) receptor antagonist indicated for the treatment of moderate to severe vasomotor symptoms due to menopause.

CONTRAINDICATIONS
VEOZAH is contraindicated in women with any of the following: • Known cirrhosis • Severe renal impairment or end-stage renal disease • Concomitant use with CYP1A2 inhibitors

WARNINGS AND PRECAUTIONS
Hepatotoxicity
In 3 clinical trials, elevations in serum transaminase [alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST)] levels > 3x ULN occurred in 2.3% of women receiving VEOZAH and 0.9% of women receiving placebo. No elevations in serum total bilirubin (> 2x ULN) occurred. Women with ALT or AST elevations were generally asymptomatic. Transaminase levels returned to pretreatment levels (or close to these) without sequelae with dose continuation, and upon dose interruption, or discontinuation. Women with cirrhosis were not studied.

In the postmarketing setting, cases of drug-induced liver injury with elevations of ALT, AST, alkaline phosphatase (ALP), and total bilirubin occurred within 40 days of starting VEOZAH. Patients reported a general sense of feeling unwell and symptoms of fatigue, nausea, pruritus, jaundice, pale feces, and dark urine. The patients’ signs and symptoms gradually resolved after discontinuation of VEOZAH.

Perform baseline hepatic laboratory tests to evaluate for hepatic function and injury [including serum ALT, serum AST, serum ALP, and serum bilirubin (total and direct)] prior to VEOZAH initiation. Do not start VEOZAH if ALT or AST is ≥ 2x ULN or if the total bilirubin is ≥ 2x ULN for the evaluating laboratory.

Perform follow-up hepatic laboratory tests monthly for the first 3 months, at 6 months, and 9 months after initiation of therapy.

See BOXED WARNING for full hepatic laboratory testing protocol and discontinuation criteria. Exclude alternative causes of hepatic laboratory test elevations.

ADVERSE REACTIONS
The most common adverse reactions with VEOZAH ≥ 2% and > placebo (VEOZAH % vs. placebo %) are: abdominal pain (4.3% vs. 2.1%), diarrhea (3.9% vs. 2.6%), insomnia (3.9% vs. 1.8%), back pain (3.0% vs. 2.1%), hot flush (2.5% vs. 1.6%), and hepatic transaminase elevation (2.3% vs. 0.8%).

INDICATIONS AND USAGE

IMPORTANT SAFETY INFORMATION


What is VEOZAH™ (fezolinetant)?

VEOZAH™ (fezolinetant) is a neurokinin 3 (NK3) receptor antagonist indicated for the treatment of moderate to severe vasomotor symptoms due to menopause.

WARNING: RISKS OF HEPATOTOXICITY
Hepatotoxicity has occurred with the use of VEOZAH in the postmarketing setting.

  • Perform hepatic laboratory tests prior to initiation of treatment to evaluate for hepatic function and injury. Do not start VEOZAH if either aminotransferase is ≥ 2x the upper limit of normal (ULN) or if the total bilirubin is ≥ 2x ULN for the evaluating laboratory.
  • Perform follow-up hepatic laboratory testing monthly for the first 3 months, at 6 months, and 9 months of treatment.
  • Advise patients to discontinue VEOZAH immediately and seek medical attention including hepatic laboratory tests if they experience signs or symptoms that may suggest liver injury (new onset fatigue, decreased appetite, nausea, vomiting, pruritus, jaundice, pale feces, dark urine, or abdominal pain).
  • Discontinue VEOZAH if transaminase elevations are > 5x ULN, or if transaminase elevations are > 3x ULN and the total bilirubin level is > 2x ULN.
  • If transaminase elevations > 3x ULN occur, perform more frequent follow-up hepatic laboratory tests until resolution.

INDICATIONS AND USAGE
VEOZAH™ (fezolinetant) is a neurokinin 3 (NK3) receptor antagonist indicated for the treatment of moderate to severe vasomotor symptoms due to menopause.

CONTRAINDICATIONS
VEOZAH is contraindicated in women with any of the following: • Known cirrhosis • Severe renal impairment or end-stage renal disease • Concomitant use with CYP1A2 inhibitors

WARNINGS AND PRECAUTIONS
Hepatotoxicity
In 3 clinical trials, elevations in serum transaminase [alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST)] levels > 3x ULN occurred in 2.3% of women receiving VEOZAH and 0.9% of women receiving placebo. No elevations in serum total bilirubin (> 2x ULN) occurred. Women with ALT or AST elevations were generally asymptomatic. Transaminase levels returned to pretreatment levels (or close to these) without sequelae with dose continuation, and upon dose interruption, or discontinuation. Women with cirrhosis were not studied.

In the postmarketing setting, cases of drug-induced liver injury with elevations of ALT, AST, alkaline phosphatase (ALP), and total bilirubin occurred within 40 days of starting VEOZAH. Patients reported a general sense of feeling unwell and symptoms of fatigue, nausea, pruritus, jaundice, pale feces, and dark urine. The patients’ signs and symptoms gradually resolved after discontinuation of VEOZAH.

Perform baseline hepatic laboratory tests to evaluate for hepatic function and injury [including serum ALT, serum AST, serum ALP, and serum bilirubin (total and direct)] prior to VEOZAH initiation. Do not start VEOZAH if ALT or AST is ≥ 2x ULN or if the total bilirubin is ≥ 2x ULN for the evaluating laboratory.

Perform follow-up hepatic laboratory tests monthly for the first 3 months, at 6 months, and 9 months after initiation of therapy.

See BOXED WARNING for full hepatic laboratory testing protocol and discontinuation criteria. Exclude alternative causes of hepatic laboratory test elevations.

ADVERSE REACTIONS
The most common adverse reactions with VEOZAH ≥ 2% and > placebo (VEOZAH % vs. placebo %) are: abdominal pain (4.3% vs. 2.1%), diarrhea (3.9% vs. 2.6%), insomnia (3.9% vs. 1.8%), back pain (3.0% vs. 2.1%), hot flush (2.5% vs. 1.6%), and hepatic transaminase elevation (2.3% vs. 0.8%).


References:

  1. Veozah. Package insert. Northbrook, IL: Astellas Pharma US, Inc; 2024.
  1. Thurston RC. Vasomotor symptoms. In: Crandall CJ, Bachman GA, Faubion SS, et al., eds. Menopause Practice: A Clinician’s Guide. 6th ed. Pepper Pike, OH: The North American Menopause Society, 2019:43-55.
  1. Nappi RE, Kroll R, Siddiqui E, et al. Global cross-sectional survey of women with vasomotor symptoms associated with menopause: prevalence and quality of life burden. Menopause. 2021;28(8):875-882. doi:10.1097/GME.0000000000001793.
  1. Chedraui P, Perez-Lopez FR, Mendoza M, et al. Factors related to increased daytime sleepiness during the menopausal transition as evaluated by the Epworth Sleepiness Scale. Maturitas. 2009;65(2010):75-80. doi:10.1016/j.maturitas.2009.11.003.
  1. Santoro N, Epperson CN,  Mathews SB. Menopausal symptoms and their management. Endocrinol Metab Clin North Am. 2015;44(3):497-515. doi:10.1016/j.ecl.2015.05.001.
  1. Kagan R, Cano A, Nappi RE, et al. Safety of fezolinetant for treatment of moderate to severe vasomotor symptoms due to menopause: pooled analysis of three randomized phase 3 studies. Adv Ther. 2025;42(2):1147-1164. doi:10.1007/s12325-024-03073-8.
  1. Neal-Perry G, Cano A, Lederman S, et al. Safety of fezolinetant for vasomotor symptoms associated with menopause: a randomized controlled trial. Obstet Gynecol. 2023;141(4):737-747. doi:10.1097/AOG.0000000000005114.
  1. Astellas. VEOZAH. Data on File.