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raloxifene hydrochloride

(rah lox' i feen)


Evista

Pregnancy Category X

Drug class
Selective estrogen receptor modulator

Therapeutic actions
Increases bone mineral density without stimulating endometrium in women; modulates
effects of endogenous estrogen at specific receptor sites.

Indications
• Prevention and treatment of osteoporosis in postmenopausal women

Contraindications and cautions


• Contraindicated with allergy to raloxifene, pregnancy, lactation, active or history
of DVT, pulmonary embolism, or retinal vein thrombosis.
• Use cautiously with history of smoking, venous thrombosis.

Available forms
Tablets—60 mg

Dosages
ADULTS
60 mg PO daily.

Pharmacokinetics
Route Onset Peak
Oral Varies 4–7 hr

Metabolism: Hepatic; T1/2: 27.7 hr


Distribution: Crosses placenta; enters breast milk
Excretion: Feces

Adverse effects
• CNS: Depression, insomnia, vertigo, neuralgia, hypoesthesia
• CV: Venous thromboembolism
• Dermatologic: Hot flashes, skin rash
• GI: Nausea, vomiting, food distaste
• GU: Vaginal bleeding, vaginal discharge
• Other: Peripheral edema

Interactions
Drug-drug
• Increased risk of bleeding with oral anticoagulants; monitor PT or INR closely
• Decreased raloxifene absorption if taken with cholestyramine; avoid this
combination

Nursing considerations
Assessment
• History: Allergy to raloxifene, pregnancy, lactation, smoking, history of venous
thrombosis
• Physical: Skin lesions, color, turgor; pelvic exam; orientation, affect, reflexes;
peripheral pulses, edema; liver function tests, CBC and differential, bone density

Interventions
• Administer daily without regard to food.
• Arrange for periodic blood counts during therapy.
• Monitor patient for possible long-term effects, including cancers, thromboses
associated with other drugs in this class.
• Counsel patient about the need to use contraceptive measures to avoid pregnancy
while taking this drug; inform patient that serious fetal harm could occur.
• Provide comfort measures to help patient deal with drug effects: Hot flashes
(environmental temperature control); headache, depression (monitor light and
noise); vaginal bleeding (use good hygiene).

Teaching points
• Take this drug as prescribed.
• This drug can cause serious fetal harm and must not be taken during pregnancy.
Contraceptive measures should be used while you are taking this drug. If you
become pregnant or would like to become pregnant, consult with your physician
immediately.
• These side effects may occur: Bone pain; hot flashes (staying in cool places may
help); nausea, vomiting (eat frequent small meals); weight gain; dizziness,
headache, light-headedness (use caution if driving or performing tasks that require
alertness).
• Report marked weakness, sleepiness, mental confusion, pain or swelling of the
legs, shortness of breath, blurred vision.

Adverse effects in Italic are most common; those in Bold are life-threatening.

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