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The People's Pharmacy

Fosamax and Evista Work in Very Different Ways


Question: I have been afraid to take Premarin because of a family history of breast cancer. I saw an article about Evista, and my doctor agreed it would be a good alternative. But after the initial prescription, the HMO would not pay for it.

My doctor then changed the prescription to Fosamax. When I questioned this change, the nurse told me Fosamax is the same as Evista. Is it really the same, or should I insist on Evista, which is supposed to be a substitute for estrogen replacement therapy?

Fosamax is a pain to take, since it must be swallowed well before breakfast. When I have a tight schedule, I have to get up half an hour earlier.

Answer: Fosamax (alendronate) is not the same as Evista (raloxifene). Both drugs are for osteoporosis, but they work in completely different ways.

Evista's estrogen-like effect slows bone loss. It also has anti-estrogen activity in the breast and may reduce the risk of breast cancer. Fosamax reduces bone breakdown but has no estrogenic effects.

Fosamax must be taken with plain water on an empty stomach. You have to wait at least 30 minutes before consuming food, coffee or orange juice, or you will not get the full benefit of the medicine.


Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Send questions to them at People's Pharmacy, c/o King Features Syndicate, 235 E. 45th St., New York, NY 10017, or e-mail them via their Web site:

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