Do I need to stop taking Evista (raloxifene) before dental surgery?

Raloxifene Management for Dental Surgery

You can continue taking Evista (raloxifene) during dental surgery as it does not need to be discontinued for minor dental procedures. 1, 2

Rationale for Continuing Raloxifene

Raloxifene (Evista) is a selective estrogen receptor modulator (SERM) used for osteoporosis prevention/treatment and breast cancer risk reduction in postmenopausal women. Unlike anticoagulants such as warfarin or direct oral anticoagulants, raloxifene does not directly affect primary hemostasis or the coagulation cascade in a way that would significantly increase bleeding risk during dental procedures.

Key Points:

• Raloxifene is not mentioned in any guidelines regarding medication discontinuation before dental procedures 1
• The FDA label for Evista (raloxifene) does not recommend discontinuation before minor procedures such as dental surgery 2
• The only procedure-related discontinuation mentioned in the FDA label is for prolonged immobilization (e.g., post-surgical recovery, prolonged bed rest), where raloxifene should be stopped at least 72 hours prior 2

Risk Assessment

While raloxifene does carry a risk of venous thromboembolism (VTE), this risk is different from the bleeding risk associated with anticoagulants:

1. Raloxifene increases VTE risk (deep vein thrombosis, pulmonary embolism) but does not directly increase bleeding risk during procedures 2, 3
2. The VTE risk with raloxifene is approximately 3 times higher than placebo but is still considered rare 4, 5
3. Minor dental procedures are associated with minimal immobilization and do not significantly increase thrombosis risk

Recommendations for Dental Surgery

• Continue raloxifene without interruption for dental procedures 2
• Inform your dentist that you are taking raloxifene
• Ensure good local hemostasis measures during and after the procedure:
  • Local pressure application
  • Sutures if needed
  • Consider tranexamic acid mouthwash if recommended by your dentist 1

Important Considerations

• If your dental surgery requires prolonged immobilization or bed rest afterward (which is uncommon for standard dental procedures), discuss with your physician about temporarily stopping raloxifene 72 hours before the period of immobilization 2
• Resume raloxifene only after you return to normal mobility 2
• The risk of stopping raloxifene briefly (for a few days) has minimal impact on its long-term benefits for osteoporosis or breast cancer prevention 3, 5

When to Consult Your Physician

Consult your physician before dental surgery if you have:

• History of blood clots, stroke, or TIA
• Additional risk factors for VTE
• Other medications that might increase bleeding risk (e.g., aspirin, NSAIDs)
• Complex dental surgery requiring prolonged recovery or immobilization

Remember that while guidelines extensively discuss management of anticoagulants and antiplatelet medications for dental procedures, raloxifene is not included in these recommendations because it does not significantly impact surgical bleeding risk.