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Evista

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Evista, Raloxifene, Droloxifene, Idoxifene, Toremifene, Selective Estrogen Receptor Modulator, SERM

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