Pharm
Evista
search
Evista
, Raloxifene
See Also
Tamoxifen
Selective Estrogen Receptor Modulator
Indications
Osteoporosis Prevention
in postmenopausal women
Hormone Replacement
in postmenopausal women
Beyond hot flash stage
Estrogen Replacement
contraindicated (
Breast Cancer
)
Breast
Cancer Prevention
in post-menopausal women
Breast Cancer
risk >1.66% in 5 years
Contraindications
Venous Thromboembolism
Perioperative period
Prolonged immobilization
History of
Cerebrovascular Accident
(CVA) or
Transient Ischemic Attack
(TIA)
Mechanism
Positive
Estrogen
effects
Stimulates bone mineralization
Improves lipid profile
Anti-
Estrogen
ic effects
No
Breast
stimulation
No uterine stimulation
Efficacy
Lower efficacy than
Tamoxifen
for breast
Cancer Prevention
(but lower
Venous Thromboembolism
,
Endometrial Cancer Risks
)
Advantages
No Uterine endometrial stimulation (unlike
Estrogen
)
Does not require concurrent
Progestin
use
Does not stimulate
Breast
tissue (unlike
Estrogen
)
No
Breast
swelling, tenderness, or pain
No data yet on
Breast Cancer
Increases
Bone Mineral Density
Modest effect (1-2%) at hip, spine, and long bones
Not as effective as
Estrogen Replacement
Positive lipid effects
Lowers LDL 10-12%
Lowers
Total Cholesterol
6-7%
Helps stabilize pelvic floor
Protects against
Uterine Prolapse
Decreases
Incidence
of
Urinary Incontinence
Reduces pelvic surgery rate by 50%
Goldstein (2001) Obstet Gynecol 98:91-6 [PubMed]
Precautions
DVT, PE and
Cardiovascular Risk
is an FDA black box warning
Disadvantages
Expensive: $65/month (Premarin is $20/month)
Anti-
Estrogen
effects (
Hot Flashes
)
Adverse Effects
Hot Flashes
(24.6%)
Leg Cramp
s (5.9%)
Increased
Deep Vein Thrombosis
and
Thromboembolism
risk
More likely to occur in first 4 months of treatment
Similar to risk with
Estrogen Replacement
Dosing
Raloxifene 60 mg PO daily
Course of 5 years if used for breast
Cancer Prevention
Reference
Delmas (1997) N Engl J Med 337:1641-7 [PubMed]
Scott (1999) Am Fam Physician 60:1131-9 [PubMed]
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