Raloxifene
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| Systematic (IUPAC) name | |
|---|---|
| [6-hydroxy-2-(4-hydroxyphenyl)- benzothiophen-3-yl]- [4-[2-(1-piperidyl)ethoxy]phenyl] -methanone | |
| Identifiers | |
| CAS number | 84449-90-1 |
| ATC code | G03XC01 |
| PubChem | 5035 |
| DrugBank | APRD00400 |
| Chemical data | |
| Formula | C28H27NO4S |
| Mol. mass | 473.584 g/mol |
| SMILES | eMolecules & PubChem |
| Pharmacokinetic data | |
| Bioavailability | 2% |
| Protein binding | 95% |
| Metabolism | Hepatic glucuronidation CYP system not involved |
| Half life | 27.7 hours |
| Excretion | Fecal |
| Therapeutic considerations | |
| Licence data | |
| Pregnancy cat. | |
| Legal status |
℞ Prescription only |
| Routes | Oral |
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Raloxifene is an oral selective estrogen receptor modulator (SERM) that has estrogenic actions on bone and anti-estrogenic actions on the uterus and breast. It is used in the prevention of osteoporosis in postmenopausal women. Raloxifene is manufactured by Eli Lilly and Company and is sold under the brand name Evista.
On April 17, 2006, it was announced that raloxifene was as effective as tamoxifen in reducing the incidence of breast cancer in certain high risk groups of females, [1] though with a reduced risk of thromboembolic events and cataracts in patients taking raloxifene versus those taking tamoxifen.[1] On September 14, 2007, the U.S. Food and Drug Administration announced approval of raloxifene for reducing the risk of invasive breast cancer in postmenopausal women with osteoporosis and in postmenopausal women at high risk for invasive breast cancer.[2]
There has been criticism in the mainstream oncology press of the way that information about the drug was released.[3] There has been some confusion in the lay media about the meaning of the trial results. There is no specific clinical evidence for the use of raloxifene in the adjuvant treatment of breast cancer rather than established drugs such as tamoxifen or anastrozole [4].
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[edit] Description
Raloxifene hydrochloride (HCl) has the empirical formula C28H27NO4S•HCl, which corresponds to a molecular weight of 510.05 g/mol. Raloxifene HCl is an off-white to pale-yellow solid that is slightly soluble in water.
SERMs mimic estrogen in some tissues and have anti-estrogen activity in others. Other SERMs, such as Pfizer's lasofoxifene and Wyeth's bazedoxifene are in the later development phases.
[edit] Indication
Raloxifene is indicated for the treatment and prevention of osteoporosis in postmenopausal women, for reduction in risk of invasive breast cancer in postmenopausal women with osteoporosis. For either osteoporosis treatment or prevention, supplemental calcium and/or vitamin D should be added to the diet if daily intake is inadequate.
[edit] Contraindications and precautions
Raloxifene is contraindicated in lactating women or women who are or may become pregnant, in women with active or past history of venous thromboembolic events, including deep vein thrombosis, pulmonary embolism, and retinal vein thrombosis and in women known to be hypersensitive to raloxifene.
[edit] Adverse reactions
Common adverse events considered to be drug-related were hot flashes and leg cramps.[citation needed]
Raloxifene may infrequently cause serious blood clots to form in the legs, lungs, or eyes. Other reactions experienced include leg swelling/pain, trouble breathing, chest pain, vision changes. Raloxifene is a teratogenic drug.
In a 2006 study published in New England Journal of Medicine, raloxifene produced significantly more strokes and blood clots than the placebo.[2]
A report in September 2009 from Health and Human Services' Agency for Healthcare Research and Quality suggests that tamoxifen, raloxifene, and tibolone used to treat breast cancer significantly reduce invasive breast cancer in midlife and older women, but also increase the risk of adverse side effects.[5]
[edit] As cancer drug
Raloxifene reduces the risk of hormone-positive breast cancer and vertebral fractures "without a shadow of a doubt," but its effects on cardiovascular disease remain less certain, according to the results of the "Raloxifene for Use of the Heart" (RUTH) study published in the July 13, 2006 issue of the New England Journal of Medicine by Dr. Elizabeth Barrett-Connor (University of California at San Diego) and colleagues.[6]
In the trial, in women with coronary heart disease (CHD) or multiple risk factors for CHD, raloxifene had no significant effect on the primary end point, coronary events, but it did significantly increase the risk of venous thromboembolism (VTE). And although the drug had no effect on stroke, there was a seemingly paradoxical significant increase in death from stroke.[7]
On September 14, 2007, Steven K. Galson, the director of the United States Food and Drug Administration's Center for Drug Evaluation and Research announced authorization of the sale of raloxifene to prevent invasive breast cancer in post-menopausal women.[8]
[edit] References
- ^ Vogel, Victor; Joseph Constantino, Lawrence Wickerman et al. (2006-06-21). "Effects of Tamoxifen vs. Raloxifene on the Risk of Developing Invasive Breast Cancer and Other Disease Outcomes". The Journal of the American Medical Association 295 (23): 2727–2741. doi:. PMID 16754727.
- ^ U.S. Food and Drug Administration (2007-09-14). "FDA Approves New Uses for Evista". Press release. http://www.fda.gov/bbs/topics/NEWS/2007/NEW01698.html. Retrieved 2007-09-15.
- ^ Thelancetoncology, (2006). "A STARring role for raloxifene?". Lancet Oncol 7 (6): 443. doi:. PMID 16750489.
- ^ http://www.cancer.gov/clinicaltrials/digestpage/STAR/page2
- ^ OncoGenetics.Org (September 2009). "Medications Effective in Reducing Risk of Breast Cancer But Increase Risk of Adverse Effects". OncoGenetics.Org. http://www.oncogenetics.org/web/Medications-Effective-in-Reducing-Risk-of-Breast-Cancer-But-Increase-Risk-of-Adverse-Effects. Retrieved 2009-09-14.
- ^ Lisa Nainggolan (July 12, 2006). A balancing act: The pro and cons of raloxefene. http://www.theheart.org/article/722709.do.
- ^ Barrett-Connor E, Mosca L, Collins P, et al. (2006-07-13). "Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women". New England Journal of Medicine 355: 125–137. doi:. PMID 16837676.
- ^ AFP.google.com, US approves Lilly's Evista for breast cancer prevention
[edit] External links
- STAR: a head-to-head comparison of tamoxifen and raloxifene as breast-cancer preventatives
- Full Prescribing Information
- Position paper of the National Women's Health Network
- Heringa M (2003). "Review on raloxifene: profile of a selective estrogen receptor modulator". Int J Clin Pharmacol Ther 41 (8): 331–45. PMID 12940590.
- Barrett-Connor E (2001). "Raloxifene: risks and benefits". Ann N Y Acad Sci 949: 295–303. PMID 11795366.
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