Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
EVISTA vs DUAVEE
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Selective estrogen receptor modulator (SERM) that binds to estrogen receptors, acting as an agonist in bone and antagonist in breast and uterine tissues.
DUAVEE is a combination of conjugated estrogens (CE) and bazedoxifene (BZA). CE activates estrogen receptors (ERα and ERβ) to relieve menopausal symptoms; BZA is a selective estrogen receptor modulator (SERM) that antagonizes ER in the endometrium to prevent endometrial hyperplasia.
Treatment and prevention of osteoporosis in postmenopausal women,Reduction in risk of invasive breast cancer in postmenopausal women with osteoporosis,Reduction in risk of invasive breast cancer in postmenopausal women at high risk for breast cancer
Moderate to severe vasomotor symptoms due to menopause,Prevention of postmenopausal osteoporosis
60 mg orally once daily.
One tablet (conjugated estrogens 0.45 mg/bazedoxifene 20 mg) orally once daily.
Terminal elimination half-life is approximately 32.5 hours (range 27-39 hours) for raloxifene and its glucuronide conjugates; clinically relevant for once-daily dosing.
Conjugated estrogens: terminal half-life of estrone sulfate is approximately 10-24 hours. Bazedoxifene: terminal half-life is approximately 30 hours. Clinically, steady state is achieved within 7 days for estrogens and 10-14 days for bazedoxifene.
Extensively metabolized in the liver via glucuronidation (UGT1A1, UGT1A8, UGT1A9) and CYP3A4-mediated oxidation.
Conjugated estrogens are primarily metabolized in the liver via phase II conjugation (sulfation and glucuronidation) by enzymes such as UGT1A1, UGT1A8, UGT1A9, UGT2B7, and SULT1A1. Bazedoxifene undergoes hepatic metabolism via glucuronidation by UGT1A1, UGT1A8, UGT1A9, and UGT2B7, with minimal CYP involvement.
Raloxifene undergoes extensive glucuronidation; <0.1% excreted unchanged in urine. Approximately 95% is excreted in feces over 5 days (primarily as glucuronide conjugates). Renal elimination of unchanged drug is negligible (<0.1%).
Conjugated estrogens are primarily excreted in urine as glucuronide and sulfate conjugates, with approximately 10-15% excreted in feces via biliary elimination. Bazedoxifene is mainly eliminated in feces (85%) with minimal renal excretion (<1% as unchanged drug).
>95% bound to plasma proteins, primarily albumin and α1-acid glycoprotein.
Conjugated estrogens: extensive binding to albumin (approximately 80-85%). Bazedoxifene: highly bound (>99%) to albumin and alpha-1-acid glycoprotein.
Apparent Vd/F is approximately 1000-1500 L (not weight-based; extensive tissue distribution).
Conjugated estrogens: Vd approximately 0.5-2 L/kg, indicating distribution into total body water and tissues. Bazedoxifene: Vd approximately 1.2 L/kg, suggesting extensive tissue distribution.
Absolute oral bioavailability is approximately 2% due to extensive first-pass glucuronidation; systemic exposure is dose-proportional.
Conjugated estrogens: oral bioavailability is approximately 30-50% due to first-pass metabolism. Bazedoxifene: absolute oral bioavailability is approximately 6% due to extensive first-pass glucuronidation.
No dose adjustment required for mild to moderate renal impairment (Cr Cl ≥30 m L/min). Not recommended in severe renal impairment (Cr Cl <30 m L/min) due to lack of data.
No dosage adjustment required for mild to moderate renal impairment (Cr Cl ≥30 m L/min). Not recommended in severe renal impairment (Cr Cl <30 m L/min) due to lack of data.
Contraindicated in patients with Child-Pugh Class B or C hepatic impairment. No specific dose adjustment recommended for Child-Pugh Class A, but use with caution.
Contraindicated in Child-Pugh Class C (severe hepatic impairment). Use with caution in Child-Pugh Class A or B; no specific dose adjustment established, but monitor closely.
Safety and efficacy not established in pediatric patients; no recommended dose.
Not indicated for use in pediatric patients. Safety and efficacy have not been established.
No specific dose adjustment required; use standard adult dosing. Consider increased risk of venous thromboembolism and stroke in elderly women.
No specific dose adjustment recommended. Higher risk of adverse events (e.g., thromboembolism, stroke) in women >65 years of age; use lowest effective dose for shortest duration.
Increased risk of venous thromboembolism (VTE) and death from stroke. Not for use in women with active or history of VTE, including deep vein thrombosis, pulmonary embolism, and retinal vein thrombosis. Not for use in women with atrial fibrillation or other conditions that increase risk of stroke.
Estrogen therapy increases the risk of endometrial cancer in women with a uterus. Concomitant use of a progestin or bazedoxifene is required to reduce this risk. Cardiovascular disorders: Estrogen-alone therapy may increase risk of stroke and DVT. Estrogen plus progestin therapy increases risk of MI, stroke, invasive breast cancer, pulmonary emboli, and DVT. DUAVEE is not approved for cardiovascular disease prevention. Breast cancer: Estrogen plus progestin therapy increases risk of invasive breast cancer. Probable dementia: Estrogen plus progestin therapy increases risk in women 65+.
Risk of VTE; discontinue if VTE occurs. Risk of stroke; discontinue if stroke occurs or for prolonged immobilization. May increase risk of endometrial cancer; monitor for abnormal bleeding. Not for premenopausal women. Use with caution in patients with hepatic impairment or cholestasis. May increase triglycerides; monitor in patients with history of hypertriglyceridemia.
Cardiovascular disorders (stroke, DVT, MI, pulmonary embolism),Malignant neoplasms (endometrial cancer, breast cancer),Gallbladder disease,Hypertriglyceridemia,Fluid retention,Hypocalcemia,Hereditary angioedema,Exacerbation of endometriosis,Exacerbation of asthma, diabetes, migraine, porphyria, SLE, hepatic hemangiomas,Retinal vascular thrombosis
Active or history of VTE, pregnancy, women who may become pregnant, lactation, hypersensitivity to raloxifene, or any component of the formulation.
Undiagnosed abnormal genital bleeding,Known, suspected, or history of breast cancer,Known or suspected estrogen-dependent neoplasia,Active or past history of venous thromboembolism (VTE),Active or past history of arterial thromboembolism (e.g., stroke, MI),Known protein C, protein S, or antithrombin deficiency or other thrombophilic disorders,Hypersensitivity to any component,Pregnancy
Avoid grapefruit and grapefruit juice as they may increase raloxifene levels. No other significant food interactions.
Grapefruit juice may increase estrogen levels; avoid large amounts. No other significant food interactions. Alcohol may increase risk of liver issues; limit intake.
Pregnancy Category X. Raloxifene is contraindicated in pregnancy. In animal studies, raloxifene caused fetal abnormalities including skeletal malformations and cardiovascular defects. Human data are unavailable due to contraindication; use in pregnancy may cause fetal harm.
DUAVEE (conjugated estrogens/bazedoxifene) is contraindicated in pregnancy. Estrogens may cause fetal harm; first trimester exposure is associated with congenital anomalies including cardiovascular and limb defects. Second and third trimester exposure increases risk of urogenital abnormalities and delayed cognitive development. Bazedoxifene is a selective estrogen receptor modulator; animal studies show embryotoxicity and fetotoxicity at clinically relevant doses.
Raloxifene is excreted in rat milk; no human data available. The M/P ratio is unknown. Due to potential adverse effects on the infant, breastfeeding is not recommended during therapy.
Contraindicated during breastfeeding. Estrogens and bazedoxifene are excreted in human milk; M/P ratio not reported. Estrogens may reduce milk production and quality. Potential for adverse effects in nursing infants.
No dosing adjustments are applicable as raloxifene is contraindicated in pregnancy. Pharmacokinetic changes in pregnancy do not inform dose modifications due to the contraindication.
No dose adjustments applicable; do not use in pregnancy. Pharmacokinetic changes in pregnancy (increased clearance, volume of distribution) are irrelevant due to contraindication.
Monitor for venous thromboembolism; avoid in patients with active or history of VTE. May increase risk of stroke in postmenopausal women with coronary heart disease. No significant effect on breast cancer incidence. Administer with caution in hepatic impairment. Discontinue prior to prolonged immobilization or surgery.
DUAVEE (conjugated estrogens/bazedoxifene) is indicated for moderate-to-severe vasomotor symptoms and osteoporosis prevention in postmenopausal women with a uterus. Avoid in women with intact uterus who are not on a progestin; bazedoxifene is the progestin component. Contraindicated in women with undiagnosed abnormal genital bleeding, known/suspected pregnancy, breast cancer, estrogen-dependent neoplasia, active DVT/PE, or history of these conditions. Monitor for thromboembolic events. Not for use in women with prior hysterectomy. Discontinue if jaundice or visual disturbances occur.
Take once daily with or without food.,Report any signs of blood clots (leg pain/swelling, sudden chest pain, shortness of breath).,May cause hot flashes, leg cramps, or flu-like symptoms.,Avoid pregnancy; not indicated for premenopausal women.,Requires adequate calcium and vitamin D intake.
Take DUAVEE once daily with or without food.,This medication is for postmenopausal women with a uterus; it contains both estrogen and a progestin-like drug to protect the uterine lining.,Do not use if you have any unexplained vaginal bleeding, are pregnant, have or have had breast cancer, blood clots, or liver disease.,Report promptly any signs of blood clots (leg pain/swelling, chest pain, sudden shortness of breath) or stroke (sudden headache, vision/speech changes).,DUAVEE may increase risk of gallbladder disease, dementia (if started after age 65), and endometrial hyperplasia if the progestin component fails.,Smoking while on DUAVEE increases risk of blood clots; avoid smoking.,DUAVEE does not prevent heart attack or stroke; in fact, it may increase cardiovascular risk, especially in older women.,Store at room temperature, away from moisture and heat.,If you miss a dose, take it as soon as possible; if almost time for the next dose, skip the missed dose and resume regular schedule. Do not double dose.,You will need regular medical check-ups including mammograms and pelvic exams.
No interactions on record
No interactions on record
Explore head-to-head clinical comparisons of other medications in the same therapeutic classes.
Common clinical questions about EVISTA vs DUAVEE, answered by our medical review team.
EVISTA is a Selective Estrogen Receptor Modulator that works by Selective estrogen receptor modulator (SERM) that binds to estrogen receptors, acting as an agonist in bone and antagonist in breast and uterine tissues.. DUAVEE is a Selective Estrogen Receptor Modulator/Estrogen Combination that works by DUAVEE is a combination of conjugated estrogens (CE) and bazedoxifene (BZA). CE activates estrogen receptors (ERα and ERβ) to relieve menopausal symptoms; BZA is a selective estrogen receptor modulator (SERM) that antagonizes ER in the endometrium to prevent endometrial hyperplasia.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between EVISTA and DUAVEE depend on the specific clinical indication. These are agents from distinct pharmacological classes and are not directly interchangeable by dose. A physician or clinical pharmacist should guide any therapeutic switching decisions.
The standard adult dose of EVISTA is: 60 mg orally once daily.. The standard adult dose of DUAVEE is: One tablet (conjugated estrogens 0.45 mg/bazedoxifene 20 mg) orally once daily.. Dosing should always be individualized based on indication, renal and hepatic function, age, and other patient factors.
No direct drug-drug interaction has been formally documented between EVISTA and DUAVEE in current clinical databases. However, individual patient risk factors including other medications, organ function, and comorbidities should always be evaluated by a qualified healthcare provider.
The maternal-fetal safety profiles differ. EVISTA is classified as Category C. Pregnancy Category X. Raloxifene is contraindicated in pregnancy. In animal studies, raloxifene caused fetal abnormalities including skeletal malformations and cardiovascular defec. DUAVEE is classified as Category C. DUAVEE (conjugated estrogens/bazedoxifene) is contraindicated in pregnancy. Estrogens may cause fetal harm; first trimester exposure is associated with congenital anomalies includi. Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.