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raloxifene

Sold as Evista. Class: Selective estrogen receptor modulators. First FDA approval 12/09/1997: 29 years on the US market.

This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.

B

Score breakdown (76/100)

Safety ×35%
C
Evidence ×25%
D
Regulatory ×15%
A
Money & lawsuits ×15%
A
Options ×10%
A

Safety: 70

Evidence: 55

Regulatory history: 92

Money & lawsuits: 100

Options: 90

FDA boxed warning

WARNING: INCREASED RISK OF VENOUS THROMBOEMBOLISM AND DEATH FROM STRO Increased risk of deep vein thrombosis and pulmonary embolism have been reported with raloxifene hydrochloride tablets, USP ( 5.1 ) . Women with active or past history of venous thromboembolism should not take raloxifene hydrochloride tablets, USP ( 4.1 ). Increased risk of death due to stroke occurred in a trial in postmenopausal women with documented coronary heart disease or at increased risk for major coronary events. Consider risk-benefit balance in women at risk for stroke ( 5.2 , 14.5 ). WARNING: INCREASED RISK OF VENOUS THROMBOEMBOLISM AND DEATH FROM STROKE See full prescribing information for complete boxed warning. Increased risk of deep vein thrombosis and pulmonary embolism have been reported with raloxifene hydrochloride tablets, USP ( 5.1 ). Women with active or past history of venous thromboembolism should not take raloxifene hydrochloride tablets, USP ( 4.1 ). Increased risk of death due to stroke occurred in a trial in postmenopausal women with documented coronary heart disease or at increased risk for major coronary events. Consider risk-benefit balance in women at risk for stroke ( 5.2 , 14.5 )...

What the FDA label says

Approved uses

Raloxifene hydrochloride tablets, USP is an estrogen agonist/antagonist indicated for: Treatment and prevention of osteoporosis in postmenopausal women. ( 1.1 ) Reduction in risk of invasive breast cancer in postmenopausal women with osteoporosis. ( 1.2 ) Reduction in risk of invasive breast cancer in postmenopausal women at high risk for invasive breast cancer. ( 1.3 ) Important Limitations: Raloxifene hydrochloride tablets, USP is not indicated for the treatment of invasive breast cancer, reduction of the risk of recurrence of breast cancer, or reduction of risk of noninvasive breast cancer. 1.1 Treatment and Prevention of Osteoporosis in Postmenopausal Women Raloxifene hydrochloride tablets, USP is indicated for the treatment and prevention of osteoporosis in postmenopausal women [see Clinical Studies ( 14.1 , 14.2 )] . 1.2 Reduction in the Risk of Invasive Breast Cancer in Postmenopausal Women with Osteoporosis Raloxifene hydrochloride tablets, USP is indicated for the reduction in risk of invasive breast cancer in postmenopausal women with osteoporosis [see Clinical Studies ( 14.3 )] . 1.3 Reduction in the Risk of Invasive Breast Cancer in Postmenopausal Women at High Risk of ...

Contraindications

Active or past history of venous thromboembolism, including deep vein thrombosis, pulmonary embolism, and retinal vein thrombosis. ( 4.1 ) Pregnancy, women who may become pregnant, and nursing mothers. ( 4.2 , 8.1 , 8.3 ) 4.1 Venous Thromboembolism Raloxifene hydrochloride tablets, USP is contraindicated in women with active or past history of venous thromboembolism (VTE), including deep vein thrombosis, pulmonary embolism, and retinal vein thrombosis [see Warnings and Precautions ( 5.1 )] . 4.2 Pregnancy, Women Who May Become Pregnant, and Nursing Mothers Raloxifene hydrochloride tablets, USP is contraindicated in pregnancy, in women who may become pregnant, and in nursing mothers [see Use in Specific Populations ( 8.1 , 8.3 )] . Raloxifene hydrochloride tablets, USP may cause fetal harm when administered to a pregnant woman. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. In rabbit studies, abortion and a low rate of fetal heart anomalies (ventricular septal defects) occurred in rabbits at doses ≥0.1 mg/kg (≥0.04 times the human dose based on surface area, mg/m 2...

Warnings and precautions

Venous Thromboembolism : Increased risk of deep vein thrombosis, pulmonary embolism, and retinal vein thrombosis. Discontinue use 72 hours prior to and during prolonged immobilization. ( 5.1 , 6.1 ) Death Due to Stroke : Increased risk of death due to stroke occurred in a trial in postmenopausal women with documented coronary heart disease or at increased risk for major coronary events. No increased risk of stroke was seen in this trial. Consider risk-benefit balance in women at risk for stroke. ( 5.2 , 14.5 ) Cardiovascular Disease : Raloxifene hydrochloride tablets, USP should not be used for the primary or secondary prevention of cardiovascular disease. ( 5.3 , 14.5 ) Premenopausal Women : Use is not recommended. ( 5.4 ) Hepatic Impairment : Use with caution. ( 5.5 ) Concomitant Use with Systemic Estrogens : Not recommended. ( 5.6 ) Hypertriglyceridemia : If previous treatment with estrogen resulted in hypertriglyceridemia, monitor serum triglycerides. ( 5.7 ) 5.1 Venous Thromboembolism In clinical trials, raloxifene-treated women had an increased risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism). Other venous thromboembolic events also could occur. A ...

Adverse reactions (label)

Adverse reactions (>2% and more common than with placebo) include: hot flashes, leg cramps, peripheral edema, flu syndrome, arthralgia, sweating. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Dr. Reddy’s Laboratories, Inc at 1-888-375-3784 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The data described below reflect exposure to raloxifene in 8429 patients who were enrolled in placebo-controlled trials, including 6666 exposed for 1 year and 5685 for at least 3 years. Osteoporosis Treatment Clinical Trial (MORE) — The safety of raloxifene in the treatment of osteoporosis was assessed in a large (7705 patients) multinational, placebo- controlled trial. Duration of treatment was 36 months, and 5129 postmenopausal women were exposed to raloxifene (2557 received 60 mg/day, and 2572 received 120 mg/day). The incidence of all-cause mortality was similar among groups: 23 (0.9%) placebo,...

Recent major label changes

Boxed Warning 9/2007 Indications and Usage, Invasive Breast Cancer Risk Reduction ( 1 ) 9/2007 Warnings and Precautions, Death Due to Stroke ( 5.2 ) 7/2007 Warnings and Precautions, Cardiovascular Disease ( 5.3 ) 7/2007 Warnings and Precautions, Renal Impairment ( 5.8 ) 7/2007

Source: FDA SPL label for Raloxifene hydrochloride (Aphena Pharma Solutions - Tennessee, LLC), effective 20180427. Full label on DailyMed.

Side-effect reports sent to the FDA

These are counts of reports people filed, not rates of harm. Anyone can file one, and nobody checks whether the drug was the cause. Millions of doses are taken for every report sent, so the useful part is how this drug compares with the average across all drugs.

8,130reports that mention this drug
8,127of those blame this drug, not another one the person was taking
40%of reports describe a serious outcome, such as a hospital stay (average for all drugs: 57%)
3.3%of reports include a death, from any cause (average for all drugs: 9.1%)

Problems reported most often

Pain In Extremity · 425Body Height Decreased · 423Drug Ineffective · 411Pain · 401Arthralgia · 391Muscle Spasms · 374Fatigue · 364Nausea · 337Fall · 312Headache · 307Diarrhoea · 288Dizziness · 280Off Label Use · 280Bone Density Decreased · 254Back Pain · 250

Reports per year

20192020202120222023202420252026
468379294262229211195120

739 reports blaming this drug for every million Medicare prescriptions filled, which is 0.3× the typical drug on this site. (525 reports in 2024–2026, against 710,154 Medicare fills in one year. This is the one number here that accounts for how many people take the drug.)

Source: the FDA's Adverse Event Reporting System (FAERS). Reports are voluntary and unverified. Drugs that are prescribed a lot, in the news, or in lawsuits attract more reports, so the percentages are compared with the whole database to correct for that partly, not fully.

Recalls and regulatory record

1recall actions on file
2 / 8brand / generic applications
0label changes since 2021
NoREMS program
DateClassFirmReason
12/2019Class IIAmerican Health PackagingFailed Dissolution Specifications: Low out of specification results obtained during stability testing.

Class I = reasonable probability of serious harm. Class II = temporary or reversible harm. Class III = unlikely to harm. Most generic recalls are manufacturing or labeling defects for one lot, not a verdict on the molecule.

Evidence base

350randomized trials (PubMed)
24systematic reviews
86registered trials
21%of completed trials posted results
5%terminated or withdrawn
44%industry-funded

Counts measure how much evidence exists and how transparent it is, not how big the benefit is. For that, ask your prescriber: if 100 people like me took this, how many would get better because of it, and how many would be harmed? (Doctors call these the "number needed to treat" and "number needed to harm.") It differs by condition and is the number drug ads leave out. Sources: PubMed, ClinicalTrials.gov.

Money and lawsuits

In 2024, drug companies reported $0 in payments to US physicians and hospitals tied to this drug across 0 transactions.

No pending federal MDL names this drug or its brands.

Not named in any federal pharmaceutical settlement of $100M or more on record.

Sources: CMS Open Payments (Sunshine Act); Judicial Panel on Multidistrict Litigation pending docket list; DOJ settlements as tabulated on Wikipedia with links to the primary record. State-court and individual suits are not included.

Who takes it and what it costs

170,494Medicare Part D patients (2024)
710,154prescriptions filled
$46average cost per fill
$33Mtotal Medicare spend
ProductFills$/fill
Raloxifene HCl707,799$45
Evista2,355$393

Same-class alternatives

bazedoxifeneospemifene

Same ATC pharmacological class, graded ones first, best grade at the top. Being in the same class does not make them interchangeable for your condition; it makes them worth asking about.

Questions to ask your prescriber

  1. This drug carries a boxed warning. Which specific risk does it cover, and does it apply to me?
  2. The most-reported problems in FDA's adverse event data are pain in extremity, body height decreased, pain. How would we recognize and handle those?
  3. Why this one over bazedoxifene, ospemifene? What would make you pick one of those instead?
  4. What result are we expecting, by when, and what is the plan if it does not happen?
  5. If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)