Can I take Evista (raloxifene) and tamoxifen together?

Concurrent Use of Evista (Raloxifene) and Tamoxifen

No, you should not take Evista (raloxifene) and tamoxifen together as this combination is not recommended based on current clinical guidelines. 1

Rationale for Not Combining These Medications

• Both medications are selective estrogen receptor modulators (SERMs) that work through similar mechanisms by binding to estrogen receptors 2
• There is no evidence supporting the combined use of these agents for breast cancer risk reduction 1
• Clinical guidelines specifically do not recommend concurrent use of these medications 1
• The medications are considered alternative options to each other, not complementary therapies 1

Appropriate Use of Tamoxifen

• Tamoxifen (20 mg daily for 5 years) is indicated for:
  • Premenopausal and postmenopausal women at increased risk of breast cancer 1
  • Reduces risk of estrogen receptor (ER)-positive invasive breast cancer 1
  • First-line option for breast cancer risk reduction in premenopausal women 2
• Tamoxifen should not be used in combination with hormone therapy 1
• Duration should be limited to 5 years outside of clinical trials 1

Appropriate Use of Raloxifene (Evista)

• Raloxifene (60 mg daily for 5 years) is indicated for:
  • Postmenopausal women only 1
  • Reduces risk of invasive ER-positive breast cancer 3
  • Treatment and prevention of osteoporosis in postmenopausal women 3
• Raloxifene has a more favorable side effect profile than tamoxifen regarding:
  • Lower risk of thromboembolic disease 1
  • Lower risk of benign uterine complaints 1
  • Lower risk of cataracts 1
  • No increased risk of endometrial cancer (unlike tamoxifen) 2

Choosing Between Tamoxifen and Raloxifene

• For premenopausal women: Only tamoxifen is appropriate 2
• For postmenopausal women: Either medication can be considered based on:
  • Raloxifene has been shown to be equally effective as tamoxifen in reducing breast cancer risk in postmenopausal women 1
  • Raloxifene was not as effective in reducing noninvasive breast cancer compared to tamoxifen 1
  • Consider individual risk factors for side effects (thromboembolic events, endometrial cancer) 3

Contraindications for Both Medications

• History of deep vein thrombosis (DVT) 1
• Pulmonary embolism (PE) 1
• Stroke or transient ischemic attack 1
• During prolonged immobilization 1

Clinical Implications

• If you are currently taking one of these medications and considering adding the other, consult with your healthcare provider about which single agent is most appropriate for your specific situation 1
• The choice between tamoxifen and raloxifene should be based on your menopausal status, risk factors, and potential side effects 3
• Both medications are used for risk reduction, not for treatment of established breast cancer 1