Short answer: Evista (raloxifene) is a 60 mg daily tablet to treat or prevent postmenopausal osteoporosis and lower invasive breast cancer risk.1 Duavee pairs conjugated estrogens with bazedoxifene, for women with a uterus, to treat hot flashes and prevent osteoporosis.2 Hot flashes are a side effect of Evista. Each has a different boxed warning, and neither label compares the two.
| Evista | Duavee | |
|---|---|---|
| What is in it | Raloxifene 60 mg, an estrogen agonist/antagonist1 | Conjugated estrogens 0.45 mg with bazedoxifene 20 mg, an estrogen agonist/antagonist2 |
| Approved for | Treat and prevent postmenopausal osteoporosis; lower invasive breast cancer risk in some postmenopausal women1 | Moderate to severe hot flashes and prevention of postmenopausal osteoporosis, in women with a uterus2 |
| How taken | One tablet daily, any time, with or without food1 | One tablet daily, with or without food, swallowed whole2 |
| Hot flashes | A side effect: 24.6% vs 18.3% on placebo in prevention trials1 | A treated symptom2 |
| Side effects in label trials | Leg cramps 7.0% vs 3.7% on placebo; flu syndrome 13.5% vs 11.4%1 | Muscle spasms 9% vs 6% on placebo; nausea 8% vs 5%; diarrhea 8% vs 5%2 |
| Before surgery or bed rest | Stop at least 72 hours before long immobilization1 | Stop 4 to 6 weeks before high-risk surgery if feasible, and during long immobilization2 |
| Missed dose | Take when remembered unless the next dose is near; never two at once1 | Take when remembered unless the next dose is near; never two at once2 |
| Boxed warning | WARNING: INCREASED RISK OF VENOUS THROMBOEMBOLISM AND DEATH FROM STROKE1 | WARNING: ENDOMETRIAL CANCER, CARDIOVASCULAR DISORDERS, AND PROBABLE DEMENTIA2 |
Evista's boxed warning covers blood clots in the legs and lungs, and a higher risk of dying from stroke seen in women with heart disease or at higher risk of it: 1.2% vs 0.8% on placebo over an average of 5.6 years in the RUTH trial.1 Duavee's boxed warning comes from its estrogen: endometrial cancer, stroke and blood clots, and probable dementia, based on Women's Health Initiative studies of conjugated estrogens 0.625 mg alone. Its bazedoxifene lowers the risk of endometrial hyperplasia, so no progestin is added.2
Neither is taken with extra estrogen: the Evista label says use with systemic estrogens is not recommended, and the Duavee label says women on it do not take progestins, additional estrogens or additional estrogen agonist/antagonists.12 Evista's label compares it with tamoxifen and with combined hormone therapy; Duavee's with placebo. These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Which, if either, fits is for your prescriber. More detail: Evista side effects, Duavee side effects, the Evista and Duavee dosing schedules, the Evista and Duavee missed-dose pages, the raloxifene and conjugated estrogens/bazedoxifene guides, and Duavee vs Prempro: how do the two menopause tablets differ?.