Raloxifene


  Issues for Surgery


Risk of venous thromboembolism (VTE) if continued1 (see Further Information).


  Advice in the Perioperative period


Elective surgery

Stop 3 days prior to surgery that will result in reduced mobility. 

If continuing, ensure adequate thromboprophylaxis.

Emergency surgery

Stop as soon as possible prior to surgery that will result in reduced mobility. 

Ensure adequate thromboprophylaxis.

Post-operative Advice

If discontinued pre-operatively, only restart when the patient is fully mobile2.


  Interaction(s) with Common Anaesthetic Agents


None1, 2, 3.


  Interaction(s) with other Common Medicines used in the Perioperative Period


None1, 2, 3.


  Further Information


Risk of VTE

The risk of VTE with raloxifene is thought to be comparable to hormone replacement therapy (HRT)2.  This has been confirmed in observational studies in the UK population, which demonstrated a statistically significant increase in VTE4.


  References


  1. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com [Accessed on 1st June 2019]
  2. Summary of Product Characteristics – Evista® (raloxifene). Daiichi Sankyo UK Limited. Accessed via www.medicines.org.uk 01/06/2019 [date of revision of the text October 2017]
  3. Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. www.medicinescomplete.com [Accessed on 1st June 2019]
  4. Vinogradova, Y. Coupland, C & Hippisley-Cox, J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases.  BMJ. 2019; 364:k4810