Drug reference
Treatment and prevention of postmenopausal osteoporosis ▶BY MOUTH ▶Adult: 60 mg once daily Breast cancer [chemoprevention in postmenopausal women at moderate to high risk] (initiated under specialist supervision) ▶BY MOUTH ▶Adult: 60 mg once daily for 5 years l UNLICENSED USE Not licensed for chemoprevention of breast cancer in the UK. Licensed for this indication in USA.
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Cholestasis. endometrial cancer. history of venous thromboembolism. undiagnosed uterine bleeding
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Avoid in Acute porphyrias p. 1120. breast cancer (manufacturer advises avoid during treatment for breast cancer). history of oestrogen-induced hypertriglyceridaemia (monitor serum triglycerides). risk factors for stroke. risk factors for venous thromboembolism (discontinue if prolonged immobilisation)
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NICE decisions ▶Raloxifene for the primary prevention of osteoporotic fragility fractures in postmenopausal women (updated February 2018) NICE TA160 Raloxifene is not recommended as a treatment option for the primary prevention of osteoporotic fragility fractures in postmenopausal women. Women who are currently receiving treatment, but for whom treatment would not have been recommended, should have the option to continue treatment until they and their NHS clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta160 ▶Raloxifene and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women (updated February 2018) NICE TA161 Raloxifene is recommended as an alternative treatment option for the secondary prevention of osteoporotic fragility fractures in postmenopausal women: . who are unable to comply with the special instructions for the administration of alendronate and risedronate, or have a contra-indication to or are intolerant of alendronate and risedronate, and . have a combination of T-score, age and number of independent clinical risk factors for fracture, as indicated in the full NICE guidance. Women who are currently receiving treatment, but for whom treatment would not have been recommended, should have the option to continue treatment until they and their NHS clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta161
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→Appendix 1: raloxifene
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▶Common or very common Influenza. leg cramps. peripheral oedema. vasodilation ▶Uncommon Embolism and thrombosis ▶Rare or very rare Breast abnormalities. gastrointestinal discomfort. gastrointestinal disorder. headaches. nausea. rash. thrombocytopenia. vomiting
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Manufacturer advises avoid (risk of increased exposure).
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Caution in mild to moderate impairment. Avoid in severe impairment.
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There can be variation in the licensing of different medicines containing the same drug. Tablet ▶Raloxifene hydrochloride (Non-proprietary) Raloxifene hydrochloride 60 mg Raloxifene 60mg tablets | 28 tablet P £17.06 DT = £3.87 | 84 tablet P £11.61–£43.50 ▶Evista (Daiichi Sankyo UK Ltd) Raloxifene hydrochloride 60 mg Evista 60mg tablets | 28 tablet P £17.06 DT = £3.87 ▶Razylan (Aspire Pharma Ltd) Raloxifene hydrochloride 60 mg Razylan 60mg tablets | 28 tablet P £17.06 DT = £3.87 OESTROGENS
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60 mg once daily
First-line fragment. Read the complete Indications and Dose section above.
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60 mg once daily for 5 years
First-line fragment. Read the complete Indications and Dose section above.
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