What You Need to Know About Veozah Side Effects

Starting a new medication always comes with questions — and when that medication carries a boxed warning, it's natural to feel cautious. Veozah (Fezolinetant) is an effective, nonhormonal treatment for moderate to severe hot flashes caused by menopause. But like all medications, it has side effects you should understand before and during treatment.

This guide breaks down the common and serious side effects of Veozah based on FDA labeling, explains the liver monitoring requirements, and helps you know exactly when to contact your doctor.

What Is Veozah?

Veozah is a neurokinin 3 (NK3) receptor antagonist made by Astellas Pharma. It works by blocking a brain receptor involved in your body's temperature regulation, which helps reduce the frequency and severity of hot flashes without using hormones. You take one 45 mg tablet by mouth once daily. For more details on how it works, see our complete guide to Veozah.

Common Side Effects

In clinical trials, most side effects of Veozah were mild to moderate. The most commonly reported side effects include:

• Abdominal pain — Stomach discomfort or cramping, usually mild and often improving over the first few weeks of treatment
• Diarrhea — Loose stools that typically resolve without treatment
• Insomnia — Difficulty falling asleep or staying asleep. This can be ironic since hot flashes themselves often disrupt sleep
• Back pain — Mild to moderate back discomfort reported in some patients
• Hot flush — Some patients experienced a temporary increase in hot flashes early in treatment before improvement (paradoxical hot flush)

These side effects affect a relatively small percentage of patients and often improve as your body adjusts to the medication. Most women in clinical trials were able to continue taking Veozah despite mild side effects.

Serious Side Effects: The Liver Warning

Veozah carries a boxed warning — the FDA's most serious warning — for hepatotoxicity (liver injury). This is the most important safety consideration with this medication.

What the Boxed Warning Says

Cases of drug-induced liver injury have been reported in patients taking Veozah. These liver problems were detected through blood tests showing elevated liver enzymes (ALT and AST) and sometimes elevated bilirubin. In clinical trials, liver injury was typically identified within the first 40 days of treatment.

Signs of Liver Problems

Stop taking Veozah and contact your doctor immediately if you experience any of these symptoms:

• Fatigue — Unusual or extreme tiredness that is new or different from your normal level
• Nausea or vomiting — Persistent stomach upset not explained by other causes
• Itching — Unexplained, generalized itching (pruritus)
• Jaundice — Yellowing of the skin or the whites of your eyes
• Pale or clay-colored stools
• Dark urine — Tea or cola-colored urine
• Right upper abdominal pain — Pain or tenderness in the area over your liver

Required Liver Monitoring

Because of this risk, your doctor is required to monitor your liver function with blood tests on a specific schedule:

1. Before starting Veozah — Baseline liver function tests (ALT, AST, bilirubin)
2. Month 1 of treatment
3. Month 2 of treatment
4. Month 3 of treatment
5. Month 6 of treatment
6. Month 9 of treatment

Your doctor should not start Veozah if your baseline liver enzymes (aminotransferases) are already 2 times or more above the upper limit of normal, or if your bilirubin is 2 times or more above normal.

If liver enzyme levels rise significantly during treatment, your doctor will discontinue Veozah. Specifically:

• Veozah must be stopped if transaminases exceed 5 times the upper limit of normal
• Veozah must be stopped if transaminases exceed 3 times the upper limit of normal AND bilirubin exceeds 2 times the upper limit of normal

Specific Populations

Veozah may not be appropriate for everyone. Here are important considerations for specific groups:

Liver Disease

Veozah is contraindicated (should not be used) in patients with cirrhosis or significant liver disease. Patients with any degree of liver impairment should be monitored very closely.

Kidney Disease

Veozah should not be used in patients with severe kidney impairment or end-stage renal disease.

Pregnancy and Breastfeeding

There is no data on using Veozah during pregnancy or while breastfeeding. Since Veozah is specifically approved for menopause symptoms, pregnancy is not expected to be a common concern — but discuss your situation with your doctor if applicable.

Drug Interactions

Veozah has significant interactions with medications that inhibit the CYP1A2 enzyme. Strong CYP1A2 inhibitors — including Fluvoxamine, Ciprofloxacin, Enoxacin, Methoxsalen, Mexiletine, and Vemurafenib — are contraindicated with Veozah. For a full list, see our Veozah drug interactions guide.

How to Manage Common Side Effects

If you experience mild side effects, these strategies may help:

For Abdominal Pain and Diarrhea

• Take Veozah with food if stomach discomfort is an issue
• Stay hydrated, especially if you're experiencing diarrhea
• Eat smaller, more frequent meals
• Avoid spicy or greasy foods in the first few weeks

For Insomnia

• Take Veozah in the morning rather than at bedtime if insomnia is a problem
• Practice good sleep hygiene — consistent bedtime, cool room, no screens before bed
• Limit caffeine, which can also interact with Veozah and worsen sleep

For Back Pain

• Over-the-counter pain relievers like Acetaminophen or Ibuprofen can help
• Gentle stretching and regular physical activity often reduce back discomfort

When to Call Your Doctor About Side Effects

Contact your healthcare provider if:

• Any side effect is severe or doesn't improve after the first few weeks
• You experience any signs of liver problems (listed above)
• You develop new or worsening symptoms that concern you
• You want to stop taking Veozah — don't discontinue without talking to your doctor first

Putting Side Effects in Perspective

The boxed warning for liver injury is serious and shouldn't be dismissed. But it's important to know that serious liver problems were uncommon in clinical trials, and the required monitoring schedule is specifically designed to catch any issues early — before they become dangerous.

For many women with moderate to severe hot flashes who can't or prefer not to take hormones, Veozah offers meaningful relief. The key is working closely with your doctor, keeping up with your liver monitoring schedule, and knowing what symptoms to watch for.

If you're considering Veozah, learn more about what it is and how it works, explore ways to save on the cost, and use Medfinder to find a pharmacy that has it in stock near you.