Classification: Selective Estrogen Receptor Modulator (SERM)
About Raloxifene (Evista®)
Raloxifene is in a class of medications called selective estrogen receptor modulators or SERMs. Most breast cancers need supplies of estrogen (a female hormone produced by the body) to grow. Raloxifene decreases the risk of developing invasive breast cancer by blocking the effects of estrogen on breast tissue. This may stop the development of tumors that need estrogen to grow. Raloxifene also prevents and treats osteoporosis by mimicking the effects of estrogen to increase the density (thickness) of bone.
How to Take Raloxifene
Raloxifene comes as a tablet to take by mouth. It is usually taken once a day, with or without food. It is important to remember to take this medication every day to get the maximum benefit from taking it. If you forget to take a dose, resume your regular schedule – do not double your dose to make up for the missed dose. Your healthcare provider may want you to take calcium and vitamin D with this medication to prevent or treat osteoporosis.
This medication can be affected by other medications. Make sure your care team and pharmacist are aware of all medications (over-the-counter and prescription) and supplements that you are taking.
Storage and Handling
Store this medication at room temperature in the original container. If you prefer to use a pillbox, discuss this with your pharmacist. Ask your oncology team where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash.
Where do I get this medication?
Raloxifene is available through most pharmacies. Your oncology team will write you a prescription to be filled at your local or mail-order pharmacy.
This medication may be covered under your prescription drug plan in full, depending upon the reason you being prescribed the medication. The Affordable Care Act dictates that if it is being prescribed to prevent breast cancer, you should have no co-pay, as long as you meet the specific criteria. Patient assistance may be available to qualifying individuals without prescription drug coverage. Co-pay cards, which reduce the patient co-pay responsibility for eligible commercially (non-government sponsored) insured patients, may also be available. Your care team can help you find these resources, if they are available.
Possible Side Effects of Raloxifene
There are a number of things you can do to manage the side effects of raloxifene. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
Hot flashes are more common in the first six months of taking raloxifene. However, there are a few things you can do to help with hot flashes. Several medications have been shown to help with symptoms, including clonidine (a blood pressure medication), low doses of certain antidepressants (such as venlafaxine and Prozac), and gabapentin. Non-medical recommendations include:
- Keep well-hydrated with eight glasses of water daily.
- Drink ice water or apply an ice pack at the onset of a hot flash.
- Wear cotton or lightweight, breathable fabrics and dress in layers so you can adjust as needed.
- Exercise on a regular basis.
- Try practicing meditation or relaxation exercises to manage stress, which can be a trigger.
- Avoid triggers such as warm rooms, spicy foods, caffeinated beverages, and alcohol.
This medication increases the risk of developing a blood clot, which most frequently occurs in the calves, and can travel from there to the lungs. Women at higher risk for developing blood clots include those with a family history of blood clots, heavy smokers, those who have an inactive lifestyle, older women, and those with other predisposing medical problems. Women with any one of these risk factors may want to consider another therapy that does not have this side effect.
Being immobile increased the risk of a blood clot. You should stop taking this medication 3 days prior to and during any prolonged immobilization (hospitalization or bed rest). When traveling, be sure to get up and move around frequently to reduce the risk of a clot.
Signs of a blood clot in the leg may include any of the following: leg pain, warmth, swelling of one leg more than the other. Signs of a blood clot in the lung could include: fever, shortness of breath that comes on very quickly, racing heart, chest pain (that tends to be worse when you take a deep breath). If you have any of these signs or symptoms of blood clots, you will need to be seen immediately so that you can be treated. Blood thinners can be given. Call your doctor or nurse.
There is a very small of developing endometrial cancer while taking this medication. Healthcare professionals believe that the benefits of this medication outweigh this risk. Women should promptly report any menstrual irregularities, vaginal bleeding, pelvic pressure/pain, or any vaginal discharge, as these may be symptoms of endometrial cancer. An endometrial biopsy should be done if any of these symptoms occur.
Other Side Effects
Other reported side effects include:
- Swelling of the feet and ankles.
- Flu-like feelings, sweating, muscle and joint aches. Acetaminophen may help with these side effects. Talk to your care provider if they become bothersome.
- Treatment with this medication can cause the triglyceride level in your blood to be elevated.
- If you are taking this medication for osteoporosis prevention, your provider may also prescribe vitamin D and calcium supplements. Try to include foods high in vitamin D and calcium in your diet and perform weight bearing exercise.
Sexual & Reproductive Concerns
Women may experience menopausal effects including hot flashes and vaginal dryness. In addition, the desire for sex may decrease during treatment.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant while on this medication. Effective birth control is necessary during treatment even if your menstrual cycle stops. You should consult with your healthcare team before breastfeeding while receiving this medication.