Raloxifene hydrochloride

How it works

It acts as an oestrogen agonist on bone, reducing bone resorption, while behaving as an oestrogen antagonist in breast and uterine tissue.

Prescribing in practice

• It increases the risk of venous thromboembolism and should be stopped before and during prolonged immobilisation; avoid in women with a history of venous thromboembolic events.
• It does not relieve menopausal vasomotor symptoms and may worsen hot flushes, so is not suitable for that purpose.
• Reduces vertebral fracture risk but, unlike bisphosphonates, has not been shown to reduce non-vertebral or hip fractures.

Monitoring

No routine blood monitoring is required, but review thrombotic risk and bone density periodically and reassess if prolonged immobility is anticipated.

Counselling the patient

• Stay mobile and tell your team in advance about planned surgery or long periods of bed rest.
• This tablet will not help hot flushes and may make them worse.
• Seek urgent help for a swollen, painful calf, chest pain or sudden breathlessness.

Evidence & guidelines

The MORE trial demonstrated reduced vertebral fracture risk with raloxifene in postmenopausal osteoporosis, and NICE includes it among options for secondary prevention.