Classification: Selective Estrogen Receptor Modulator (SERM)
About: Raloxifene (Evista®)
Raloxifene belongs to 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 including cholestyramin, warfarin, diazepam, diazoxide, and lidocaine. You should not take systemic estrogen medications while taking raloxifene; these include oral forms (pills) and topical forms (gels/patches). Be sure to tell your healthcare provider about all medications and supplements you take.
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. Keep containers out of reach of children and pets. Do not flush down the toilet or throw in the trash.
Where do I get this medication?
Raloxifene is available through retail or mail order pharmacy. Your oncology team will work with your prescription drug plan to identify an in-network, retail or mail order pharmacy for medication distribution.
This medication may be covered under your prescription drug plan in full, depending upon the reason you being prescribed the medication. 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.
If this medication is prescribed to prevent breast cancer, there should be no copay for the prescription under the rules of the Affordable Care Act.
Possible Side Effects of Raloxifene
There are a number of things you can do to manage the side effects of raloxifene. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:
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 increases 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). A blood clot in the lung is a medical emergency and requires immediate care; call 911. If you have signs or symptoms of a blood clot in the leg, call your care team immediately so that you can be treated. Blood thinners can be given.
Hot flashes are more common in the first six months of taking raloxifene. 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 fluoxetine), and gabapentin. Talk to your healthcare team about these prescription products to determine if they are right for you.
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.
There is a very small risk 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.
Less common, but important side effects can 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.
- Elevated triglycerides: Treatment with this medication can cause the triglyceride level in your blood to be elevated.
Sexual & Reproductive Concerns
This medication should only be given to women who have gone through menopause. If you are unsure if you are in menopause or if you become pregnant while taking this medication, notify your care provider.