Evista (chemical name: raloxifene) is a SERM approved by the U.S. Food and Drug Administration (FDA) to:
- reduce the risk of hormone-receptor-positive breast cancer in postmenopausal women who haven't been diagnosed but are at higher-than-average risk for disease
- reduce the risk of hormone-receptor-positive breast cancer in postmenopausal women being treated for osteoporosis who haven't been diagnosed with breast cancer
- treat and prevent osteoporosis in postmenopausal women
Evista isn't used to treat breast cancer after it's been diagnosed. Evista also won't work on hormone-receptor-negative breast cancer.
Evista is a pill that is taken once per day, with or without food. Most doctors recommend taking Evista at the same time every day.
You should not take Evista if you are breastfeeding, pregnant, trying to get pregnant, or if there is any chance that you could be pregnant. Evista may cause damage to developing embryos. You should use an effective non-hormonal type of birth control — such as condoms, a diaphragm along with spermicide, or a non-hormonal I.U.D. — while you are taking Evista. Ask your doctor which type of non-hormonal birth control would be best for you, as well as how long you should use this type of birth control after you stop taking Evista.
Benefits of Evista
The large STAR (Study of Tamoxifen and Raloxifene) trial compared Evista and tamoxifen, another SERM, to see if one medicine was better than the other at reducing the risk of invasive breast cancer in postmenopausal women. The researchers also looked at whether postmenopausal women who took Evista or tamoxifen had similar quality of life.
STAR trial results showed that Evista and tamoxifen offer the same reduction in risk — both medicines lower the risk of invasive breast cancer by about 50%. Both medicines also offer the same overall quality of life.
Like tamoxifen, Evista also can strengthen the bones of postmenopausal women and reduce the risk of osteoporosis. Evista has been shown to reduce the risk of spinal fractures due to osteoporosis.
Unlike tamoxifen, Evista isn't affected by the CYP2D6 enzyme. The body uses the CYP2D6 enzyme to convert tamoxifen into its active form. Two things can interfere with the body’s ability to make this happen: a flaw in the CYP2D6 enzyme and certain medications that block the effectiveness of this enzyme. So Evista may be a good risk-reduction option for postmenopausal women at higher-than-average risk for breast cancer who have an abnormal version of the CYP2D6 enzyme or are taking another medicine that blocks CYP2D6 activity.
Side effects of Evista
Evista's selective estrogen activation effects can cause some serious side effects, including blood clots and stroke. If you and your doctor are considering Evista as part of your treatment plan, tell your doctor if you smoke or have a history of blood clots or heart attack. If you're taking Evista, call your doctor immediately if you have any of these symptoms:
- leg pain or warmth in the calves
- swelling of the legs, hands, or feet
- chest pain
- shortness of breath
- vision problems
- difficulty speaking or understanding
- sudden severe headache
The most common side effects of Evista are:
- hot flashes
- leg cramps
- flu-like symptoms
- sleeping problems
- joint/bone pain
- dry skin
Some women on Evista have reported memory problems while taking the medicine. While no definitive results are available yet, the ongoing Co-STAR (Cognition in the Study of Tamoxifen and Raloxifene) trial is looking at the effects Evista and tamoxifen have on memory and thinking.
How long do I take Evista?
Since Evista is a relatively new medicine (it was approved by the FDA in 2007 to reduce the risk of hormone-receptor-positive breast cancer in postmenopausal women who had never been diagnosed with disease), it's not clear yet how long you should take Evista to get the most risk reduction benefits. In the STAR trial, women took Evista for 5 years. Depending on your unique situation, your doctor may recommend that you take Evista for a longer or shorter amount of time.
Does insurance cover Evista?
Costs for Evista can vary. If you have health insurance, check with your insurance company to see if and how much of the cost of Evista is covered. If you don't have health insurance or your insurance doesn't cover the cost of Evista, ask your doctor or nurse about programs in your area that may be able to help.
Eli Lilly and Company, the company that makes Evista, offers the patient assistance program Lilly Cares.
You can also read the Breastcancer.org Paying for Your Care section for information on additional types of financial assistance and cost-lowering tips.