Raloxifene Therapy and Renal Stone Risk

Known Side Effects of Raloxifene

Raloxifene is used for prevention and treatment of osteoporosis in postmenopausal women, and reduction of invasive breast cancer risk, according to the American College of Physicians and American Family Physician guidelines 1, 2
The documented side effects of raloxifene include hot flashes and leg cramps, with a strength of evidence based on clinical trials 3, 4
Raloxifene is associated with an increased risk of venous thromboembolism (0.7% for women receiving 60 mg/day raloxifene vs. 0.2% for placebo), and pulmonary emboli (0.3% for women receiving 120 mg/day raloxifene vs. 0.1% for placebo), as reported by the Journal of the National Comprehensive Cancer Network 3, 4, 5

The American College of Physicians guidelines on osteoporosis treatment do not list renal stones as a side effect of raloxifene, based on evidence from the Multiple Outcomes of Raloxifene Evaluation (MORE) trial and its extension, the Continuing Outcomes Relevant to Evista (CORE) trial 1, 2
The American Society of Clinical Oncology guidelines on breast cancer risk reduction medications do not mention renal stones as a concern with raloxifene, with a strength of evidence based on clinical trials 5

Indinavir, an HIV protease inhibitor, is known to increase the risk of kidney stones, as reported by Clinical Infectious Diseases 6
Acyclovir, ciprofloxacin, foscarnet, and sulfonamides are also known to increase the risk of kidney stones through intratubular precipitation, according to Clinical Infectious Diseases 6
Topiramate, an anticonvulsant, is associated with an increased risk of kidney stones, as reported by Gastroenterology 7

Maintaining adequate fluid intake to achieve at least 2.5 liters of urine output daily is recommended for prevention of kidney stones, according to The Journal of Urology and Annals of Internal Medicine 8, 9
Limiting dietary oxalate if oxalate stones are a concern is also recommended, based on evidence from Clinical Nutrition 10
Maintaining normal dietary calcium intake is recommended, rather than restricting it, as reported by Annals of Internal Medicine 9