Action

Binds to estrogen receptors, activating estrogen pathways and increasing bone mineral density. These effects decrease bone resorption and turnover.

Availability

Tablets: 60 mg

Indications and dosages

➣ Treatment and prevention of osteoporosis in postmenopausal women; reduction of invasive breast cancer risk in postmenopausal women with osteoporosis; reduction of invasive breast cancer risk in postmenopausal women at high risk for invasive breast cancer

Adults: 60 mg P.O. daily

Off-label uses

• Prophylaxis of cardiovascular disease

Contraindications

• Hypersensitivity to drug or its components

• History of thromboembolic events

• Premenopausal women

• Females of childbearing age

• Pregnancy or breastfeeding

• Children

Precautions

Use cautiously in:

• altered lipid metabolism, hepatic dysfunction

• concurrent estrogen therapy (use not recommended)

• immobilized patients and others at increased risk for thromboembolic events.

Administration

• Give with or without food.

Adverse reactions

CNS: depression, insomnia, vertigo, syncope, hypoesthesia, migraine, neuralgia

CV: chest pain, peripheral edema, varicose veins, deep-vein thrombosis, thrombophlebitis

EENT: conjunctivitis, sinusitis, rhinitis, pharyngitis, laryngitis

GI: nausea, vomiting, diarrhea, abdominal pain dyspepsia, flatulence, gastroenteritis

GU: urinary tract infection or disorder, cystitis, vaginitis, leukorrhea, endometrial disorder, vaginal hemorrhage

Musculoskeletal: leg cramps, joint pain, myalgia, arthritis, tendon disorder

Respiratory: cough, pneumonia, bronchitis, pulmonary embolism

Skin: rash, diaphoresis

Other: weight gain, hot flashes, infection, pain, flulike symptoms

Interactions

Drug-drug. Cholestyramine: reduced raloxifene absorption

Highly protein-bound drugs (such as diazepam, diazoxide, lidocaine): interference with binding of these drugs

Warfarin: decreased prothrombin time

Drug-diagnostic tests. Albumin, apolipoprotein B, calcium, fibrinogen, inorganic phosphate, low-density lipoproteins, platelets, protein, total cholesterol: decreased levels

Apolipoprotein A1; corticosteroid-binding, sex steroid-binding, and thyroid-binding globulin: increased levels

Patient monitoring

See Watch for thromboembolic events, especially during first 4 months of therapy.

• Stay alert for other adverse effects, particularly leg cramps, other musculoskeletal complaints, and respiratory disorders.

• Assess bone mineral density test results.

• Monitor for unexplained vaginal bleeding.

Patient teaching

• Tell patient she may take with or without food.

• Instruct patient to read package insert before starting drug and then periodically.

See Teach patient to recognize and immediately report symptoms of blood clots.

• Instruct patient to stop taking drug 3 days before anticipated period of prolonged immobility, and to restart it only after she regains normal mobility.

• Tell patient that drug may cause hot flashes, but that these are normal effects.

• Advise patient to report unexplained vaginal bleeding or leg cramps.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.