Common and Serious Evista Side Effects You Should Know About

Anyone who’s gone through menopause is likely familiar with its many symptoms — mood changes, hot flashes, and changes in libido. But menopause also brings with it the risk of certain health conditions. For example, the strength of your bones drops quickly during the first 5 to 10 years after menopause. This can lead to a condition known as osteoporosis. 

Although menopause doesn’t necessarily raise your risk for breast cancer, getting older certainly does. Older age, along with other factors, may put some women at a higher risk for breast cancer after menopause, as well.

Thankfully, there are medications that can help with these problems. Evista (raloxifene) can be used to help prevent both osteoporosis and breast cancer in certain women. It’s also used to treat osteoporosis. But it also has some serious side effects to know about. Keep reading to learn about Evista and its side effects.

What is Evista?

Evista (raloxifene) is an oral medication that’s taken once daily. It’s part of a class of medications known as selective estrogen receptor modulators (SERMs). SERMs, like Evista, act on estrogen receptors (chemical binding sites) in the cells. 

Evista is used in women who’ve gone through menopause (postmenopausal) to:

• Treat or prevent osteoporosis

• Lower the risk of invasive breast cancer in women with osteoporosis

• Lower the risk of invasive breast cancer in women with a higher-than-average risk of this type of cancer

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How does Evista work for osteoporosis?

As mentioned above, Evista binds to estrogen receptors in the cells. When it does this in bone cells, it acts similarly to the estrogen in your body. This means it slows the breakdown of bone and improves bone strength. These actions can help lower the chance of bone fractures.

How does Evista work for breast cancer prevention?

Estrogen can cause breast cancer cells to grow. Rather than acting like estrogen as it does in bone cells, it has the opposite effect in breast cells. When it binds to estrogen receptors in breast cells, it blocks estrogen’s effects. This helps lower the risk of developing breast cancers that feed off of estrogen.

Common Evista side effects

The most common side effects of Evista include:

• Hot flashes

• Leg cramps

• Flu-like symptoms

• Joint pain 

• Headache

• Nausea or diarrhea

• Swelling in the arms or legs

These side effects can occur at any time during treatment with Evista. During clinical trials, hot flashes were most common, especially within the first 6 months of treatment. They affected about 25% of those who used it for osteoporosis prevention. 

Serious Evista side effects

Evista has a few serious side effects. In fact, it has boxed warnings — the FDA’s strictest warning — about blood clots and risk of death due to stroke.

The risk of developing blood clots in your legs or lungs while taking Evista is three times higher than people not taking this medication. You shouldn’t take Evista if you have a history of blood clots. That’s because you’re more at risk for blood clots if you’ve had them in the past. 

Sitting still for a long period of time can also raise your blood clot risk. This situation might arise if you take a long car or plane ride, or if you have a surgery that requires bed rest. Your healthcare provider might suggest you stop taking Evista for a period of time before and/or after a major surgery. 

Also, you may have a higher risk for serious side effects if you have coronary artery disease (CAD). CAD is the narrowing of the arteries, which affects blood flow to the heart. Evista may raise your risk of a life-threatening stroke if you have CAD or are at high risk of CAD.

Long-term Evista side effects

If you develop a blood clot while taking Evista, you’ll likely need to take medication to prevent another one from happening. This treatment could be temporary or long-term, depending on other risk factors. Blood clots and strokes can also cause long-term health problems. And they can be life-threatening, too. 

When should I contact my healthcare provider about Evista side effects?

Contact your healthcare provider if you have any side effects that could be related to a blood clot. These can include symptoms like:

• Pain, warmth, or swelling of the leg

• Chest pain

• Problems catching your breath

• Coughing up blood

• Sudden loss or changes in vision

You should also call 911 or seek medical help right away if you notice any signs of a stroke while taking Evista. These can include symptoms like:

• Confusion

• Problems with speaking

• Problems with walking or balance

• Weakness or numbness on one side of the body

• Severe headache

Keep in mind: Evista doesn’t prevent breast cancer 100% of the time. So, it’s important to be aware of any changes in your breasts, like lumps or tenderness. You should contact your healthcare provider right away if you notice these changes.

What can I do to manage Evista side effects?

As mentioned earlier, hot flashes are the most common Evista side effect. It’s recommended to avoid caffeine, alcohol, and spicy foods if you’re experiencing them. That’s because these things can make them worse. You can also dress in layers and carry a portable fan with you.

Be sure to avoid long periods of sitting or limited movement. This can help lower your risk of blood clots. Make frequent stops to walk around when on a long car ride to get your blood flowing. 

And if you’re on a long plane ride, keep your legs moving as much as possible. Compression stockings might also be helpful for certain people who are at high risk of blood clots. Talk to your healthcare provider about whether you should stop taking Evista before a major surgery.

Some medications can make Evista side effects worse. Talk to your provider or pharmacist about any other medications you take to make sure they don’t interact with Evista.

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Written by:

Sarah Lobello Pearson, PharmD

Sarah Pearson is a practicing pharmacist with over 10 years of experience in the field. She received her doctorate in pharmacy from the University of Georgia in Athens, GA.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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