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Selective estrogen receptor modulators(SERMs)

Sedovesta (Raloxifene)
SERMs mimic estrogen in some tissues and have anti-estrogen activity in others.
Raloxifene (Sedovesta) belongs to a class of drugs called selective estrogen receptor modulators (SERMs).

Description:
Raloxifene structure 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 very slightly soluble in water.

Mode of action:
SERMs work like estrogen in some tissues but as an anti-estrogen in other tissues. The SERMs are developed to reap the benefits of estrogen while avoiding the potential side effects of estrogen. Thus, raloxifene can act like estrogen on bone, but as an anti-estrogen on the lining of the uterus.
Raloxifene (Sedovesta) is as effective as tamoxifen in reducing the incidence of breast cancer in certain high risk groups of females, which blocks the stimulative effect of estrogen on breast tissue. Tamoxifen has proven valuable in women who have had cancer in one breast in preventing cancer in the second breast. 
Raloxifene (Sedovesta) is the second SERM to be approved by the FDA. Raloxifene has been approved for the prevention and treatment of osteoporosis in postmenopausal women. In a three year study involving some 600 postmenopausal women, raloxifene was found to increase bone density and lower LDL cholesterol, while having no stimulative effect on the uterine lining (which means that it is unlikely to cause uterine cancer).

Caution:
Because of its anti-estrogen effects, the most common side effects with raloxifene are hot flashes.
Conversely, because of its estrogenic effects, raloxifene increases the risk of blood clots, including deep vein thrombosis (DVT) and pulmonary embolism (blood clots in the lung). The greatest increase in risk occurs during the first 4 months of use. Patients taking raloxifene should avoid prolonged periods of immobility during travel, when blood clots are more prone to occur. The risk of deep vein thrombosis with raloxifene is probably comparable to that of estrogen, about 2 to 3 times higher than the usual low occurrence rate.
Raloxifene (Sedovesta) decreases the risk of spine fractures in postmenopausal women with osteoporosis, but the benefit in decreasing hip fracture risk is not yet known. (The only agents that are definitely proven to decrease hip fracture risk are bisphosphonates.)

Indication:
Raloxifene is indicated for the treatment and prevention of osteoporosis in postmenopausal women.
For either osteoporosis treatment or prevention, supplemental calcium and/or vitamin D should be added to the diet if daily intake is inadequate.

Recent Updates:
The selective estrogen-receptor modulator (SERM) Raloxifene (Sedovesta) , 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 (Sedovesta) 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, San Diego) and colleagues.
In the trial, in women with coronary heart disease (CHD) or multiple risk factors for CHD, Raloxifene (Sedovesta) 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.

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