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Common adverse events related to EVISTA® therapy were hot flashes and leg cramps. Hot flashes were most commonly reported during the first 6 months of treatment and were not different from placebo thereafter.
DRUG INTERACTIONS "Cost Effectiveness of Raloxifene in the Treatment of Osteoporosis in Sweden: An Economic Evaluation Based on the More Study." Pharmacoeconomics 22.17 (2004): 1153-65.
Cholestyramine causes a 60% reduction in the absorption and enterohepatic cycling of raloxifene after a single dose. Thus, co-administration of cholestyramine with EVISTA® is not recommended.
COMPARATIVE EFFICACY
Overall, raloxifene exerts similar positive on bone mineral density and bone turnover as other SERMS and estrogen therapy. However, the reduction in fracture risk is improved with SERMs vs. estrogen (Nakamura 632).
COST ANALYSIS
Overall, administration of calcium and vitamin D is more effective and economical than any approved drug for postmenopausal osteoporosis. The annual cost of calcium and vitamin D treatment is $22 compared to $255 for estrogen, $696 for alendronate, and $723 for raloxifene. Furthermore, annualized bone mineral density is preserved to a greater extent with calcium and vitamin D at 1% vs. 0.8% with alendronate, 0.5% with estrogen, and 0.7% with raloxifene. However, in comparison to no treatment, raloxifene is a cost-effective osteoporosis treatment (Borgstrom et al. 1153).
PERSONAL PERSPECTIVE of EVISTA
Overwhelming evidence exists that EVISTA® is a safe and efficacious drug used to prevent and treat osteoporosis in postmenopausal women. The safety profile of this medication is favorable compared to estrogen because of the selective effects on the estrogen receptor. Although effects on bone mineral density are modest, EVISTA® substantially reduces fracture risk. Overall, EVISTA® should be recommended by primary care physicians to their patients who have or are at risk for osteoporosis and who have no contraindications to its use.
References
Barrett-Connor, E., et al. "Risk-Benefit Profile for Raloxifene: 4-Year Data from the Multiple Outcomes of Raloxifene Evaluation (More) Randomized Trial." J. Bone Miner Res 19.8 (2004): 1270-5.
Bryant, H.U. "Mechanism of Action and Preclinical Profile of Raloxifene, a Selective Estrogen Receptor Modulation." Rev Endocr Metab Disord 2.1 (2001): 129-38.
Cranney, a., et al. "Meta-Analyses of Therapies for Postmenopausal Osteoporosis. Iv. Meta-Analysis of Raloxifene for the Prevention and Treatment of Postmenopausal Osteoporosis." Endocr Rev 23.4 (2002): 524-8.
Duschek, E.J., L.J. Gooren, and C. Netelenbos. "Effects of Raloxifene on Gonadotrophins, Sex Hormones, Bone Turnover and Lipids in Healthy Elderly Men." Eur J. Endocrinol 150.4 (2004): 539-46.
Eng-Wong, J., and J.A. Zujewski. "Raloxifene and Its Role in Breast Cancer Prevention." Expert Rev Anticancer Ther 4.4 (2004): 523-32.
Gluck, O., and M. Maricic. "Raloxifene: Recent Information on Skeletal and Non-Skeletal Effects." Curr Opin Rheumatol 14.4 (2002): 429-32.
Grady, D., et al. "Safety and Adverse Effects Associated with Raloxifene: Multiple Outcomes of Raloxifene Evaluation." Obstet Gynecol 104.4 (2004): 837-44.
Heringa, M. "Review on Raloxifene: Profile of a Selective Estrogen Receptor Modulator." Int J. Clin Pharmacol Ther 41.8 (2003): 331-45.
Itabashi, a. "[Raloxifene Hydrochloride]." Nippon Rinsho 62 Suppl 2 (2004): 528-35.
Kellen, J.A. "Raloxifene: Another Selective Estrogen Modulator." In Vivo 15.6 (2001): 459-60.
Maricic, M., and O. Gluck. "Review of Raloxifene and Its Clinical Applications in Osteoporosis." Expert Opin Pharmacother 3.6 (2002): 767-75.
McClung, M.R. "How Does Raloxifene Reduce Fracture Risk?" Menopause 9.5 (2002): 306-8.
Nakamura, T. "[Bone Quality and Raloxifene]." Clin Calcium 14.4 (2004): 632-7.
Thiebaud, D., and R.J. Secrest. "Selective Estrogen Receptor Modulators: Mechanism of Action and Clinical Experience. Focus on Raloxifene." Reprod Fertil Dev 13.4 (2001): 331-6.
References
Barrett-Connor, E., et al. "Risk-Benefit Profile for Raloxifene: 4-Year Data from the Multiple Outcomes of Raloxifene Evaluation (More) Randomized Trial." J. Bone Miner Res 19.8 (2004): 1270-5.
Borgstrom, F., et al. "Cost Effectiveness of Raloxifene in the Treatment of Osteoporosis in Sweden: An Economic Evaluation Based on the More Study." Pharmacoeconomics 22.17 (2004): 1153-65.
Bryant, H.U. "Mechanism of Action and Preclinical Profile of Raloxifene, a Selective Estrogen Receptor Modulation." Rev Endocr Metab Disord 2.1 (2001): 129-38.
Cranney, a., et al. "Meta-Analyses of Therapies for Postmenopausal Osteoporosis. Iv. Meta-Analysis of Raloxifene for the Prevention and Treatment of Postmenopausal Osteoporosis." Endocr Rev 23.4 (2002): 524-8.
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