Raloxifene (Evista) is a selective estrogen receptor modulator (SERM), primarily used for the treatment and prevention of osteoporosis in postmenopausal women, as well as reducing the risk of invasive breast cancer in high-risk populations.

Precautions for Administration of Raloxifene (Evista)

Contraindicated Populations

History of Venous Thromboembolism: Contraindicated in patients with active or previous deep vein thrombosis, pulmonary embolism, or retinal vein thrombosis.

Pregnancy: May cause fetal malformations. Women of childbearing age must use strict contraception during medication and after discontinuing the drug. It is contraindicated during lactation.

Administration Regimen and Requirements

Dosage: Take 60 mg orally once daily, which is not affected by food intake. However, it should be taken at a fixed time to maintain stable blood drug concentration.

Management of Missed Dose: If a dose is missed, there is no need to make up for it; continue with the original schedule on the next day.

Supplementation of Calcium and Vitamin D: A daily intake of 1500 mg of calcium and 400-800 IU of vitamin D is required. Additional supplementation is needed for those with insufficient intake.

Special Risk Warnings

Risk of Venous Thromboembolism: The risk is highest in the early stage of medication (first 4 months). Prolonged immobilization (such as post-operative recovery, long-distance travel) should be avoided.

Risk of Stroke-Related Death: Women with coronary heart disease or at high risk may have an increased risk of stroke-related death, so the pros and cons need to be weighed.

Endometrial Monitoring: Although it has no estrogen-like effect, attention should be paid to abnormal uterine bleeding, and the cause should be promptly identified.

Drug Interactions

Cholestyramine: Significantly reduces the absorption of raloxifene; concurrent use should be avoided.

Warfarin: May prolong coagulation time; close monitoring of INR (International Normalized Ratio) is required.

Highly Protein-Bound Drugs (e.g., diazepam, lidocaine): May compete for binding sites; cautious concurrent use is necessary.

Medication Monitoring for Raloxifene (Evista)

Pre-Treatment Evaluation

Baseline Examinations: Include breast ultrasound/mammography, endometrial thickness (transvaginal ultrasound), bone mineral density (DXA), blood lipids, and coagulation function.

Risk Assessment: Evaluate the risk of breast cancer using the Gail model to confirm the indication.

Intra-Treatment Monitoring

Bone Health: Recheck bone mineral density every 1-2 years, and pay attention to symptoms of vertebral fractures (such as back pain, height loss).

Breast Monitoring: Conduct annual breast examinations and mammography screenings. Routine cancer prevention screenings are still necessary even during medication.

Thrombosis Symptoms: Seek medical attention immediately for sudden limb swelling and pain or dyspnea to rule out deep vein thrombosis or pulmonary embolism.

Metabolic Indicators: Patients with a history of hypertriglyceridemia need regular monitoring of blood lipids.

Long-Term Follow-Up

Adverse Reaction Management: Common adverse reactions include hot flashes (approximately 25%), leg cramps (7%), and peripheral edema (14%), which usually do not require drug discontinuation.

Efficacy Evaluation: For patients with osteoporosis, changes in fracture rate should be observed; for those at high risk of breast cancer, the risk-benefit ratio should be re-evaluated every 3-5 years.