Clonidine REF: Novak's gynecology 13th edition page 455 In women for whom hormone replacement is contraindicated, multiple alternative treatments for hot flashes have been developed. Somewhat effective alternatives may be progestins such as medroxyprogesterone (10 to 30 mg daily orally) or megestrol acetate (20 to 40 mg daily orally). If either of these progestins results in intolerable side effects, the use of alternative progestins may be considered, although few data exist regarding their efficacy. In addition to the progestins, other nonsteroidal treatments for hot flashes have been developed. One of the best studied is the b 2-adrenergic agonist, clonidine. This drug probably works through both central and peripheral mechanisms and can be given either orally (0.05 mg twice daily) or by transdermal patch.