II. 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
III. Contraindications
- Venous Thromboembolism
- Perioperative period
- Prolonged immobilization
- History of Cerebrovascular Accident (CVA) or Transient Ischemic Attack (TIA)
IV. Mechanism
V. Efficacy
- Lower efficacy than Tamoxifen for breast Cancer Prevention (but lower Venous Thromboembolism, Endometrial Cancer Risks)
VI. 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]
VII. Precautions
- DVT, PE and Cardiovascular Risk is an FDA black box warning
VIII. Disadvantages
- Expensive: $65/month (Premarin is $20/month)
- Anti-Estrogen effects (Hot Flashes)
IX. Adverse Effects
- Hot Flashes (24.6%)
- Leg Cramps (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
X. Dosing
- Raloxifene 60 mg PO daily
- Course of 5 years if used for breast Cancer Prevention
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Related Studies
| raloxifene (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| RALOXIFENE HCL 60 MG TABLET | Generic | $0.28 each |