Etoricoxib is a highly selective, second-generation cyclooxygenase-2 (COX-2) inhibitor, classified as a nonsteroidal anti-inflammatory drug (NSAID). It is specifically designed to provide potent anti-inflammatory and analgesic effects while minimizing the gastrointestinal (GI) toxicity associated with non-selective NSAIDs. The 90mg strength is a standard therapeutic dose for chronic conditions like osteoarthritis and rheumatoid arthritis in the Indian market. It is extensively used for its once-daily dosing convenience, leading to better patient compliance.
Adult: Osteoarthritis: 60mg once daily. Rheumatoid Arthritis: 90mg once daily. Ankylosing Spondylitis: 90mg once daily. Acute Gouty Arthritis: 120mg once daily (for a maximum of 8 days). Acute Pain & Primary Dysmenorrhea: 120mg once daily (for a maximum of 8 days).
Note: Can be taken with or without food. Swallow the tablet whole with a glass of water. Do not crush, chew, or break. The lowest effective dose should be used for the shortest possible duration. Missed Dose: If forgotten, take it as soon as remembered. If it is almost time for the next dose, skip the missed dose. Do not double the dose.
Etoricoxib selectively inhibits the enzyme cyclooxygenase-2 (COX-2). COX-2 is induced during inflammation and is responsible for the synthesis of prostanoids (prostaglandins, prostacyclin, thromboxane) that mediate pain, inflammation, and fever. By selectively inhibiting COX-2, etoricoxib reduces the production of these inflammatory prostaglandins (like PGE2) at the site of injury, providing analgesic and anti-inflammatory effects.
Pregnancy: Pregnancy Category C (US FDA). Avoid use in first and second trimesters unless potential benefit justifies potential risk. Contraindicated in the third trimester due to risk of premature closure of the ductus arteriosus, oligohydramnios, and inhibition of labor. May cause fetal renal dysfunction and increased risk of bleeding in mother and neonate.
Driving: Dizziness, vertigo, somnolence, and blurred vision have been reported. Patients should be cautioned about operating machinery or driving until they are reasonably certain etoricoxib does not affect them adversely.
| Warfarin/Acenocoumarol | Increased risk of bleeding due to potential pharmacodynamic interaction (no PK effect, but anti-inflammatory effect may mask signs of bleeding). Monitor INR closely. | Major |
| Lithium | Etoricoxib may decrease renal lithium clearance, leading to increased lithium plasma levels and risk of toxicity. Monitor lithium levels. | Major |
| Methotrexate | NSAIDs may reduce renal excretion of methotrexate, increasing its toxicity. Use with caution, especially at high methotrexate doses. Monitor for hematological and renal toxicity. | Major |
| Diuretics (Furosemide, Thiazides) | Reduced diuretic and antihypertensive efficacy. Increased risk of renal impairment due to decreased prostaglandin-mediated renal blood flow. | Moderate |
| ACE Inhibitors (Ramipril, Enalapril) / ARBs (Losartan, Telmisartan) | Reduced antihypertensive effect. Increased risk of renal impairment, particularly in volume-depleted patients. | Moderate |
| Cyclosporine, Tacrolimus | Increased risk of nephrotoxicity. Monitor renal function. | Moderate |
| Aspirin (low-dose, cardioprotective) | Concomitant use may increase risk of GI ulceration and bleeding. Etoricoxib does not interfere with the antiplatelet effect of aspirin. | Moderate |
| Other NSAIDs (including selective COX-2 inhibitors) | Increased risk of GI and renal adverse effects without added therapeutic benefit. Avoid concomitant use. | Major |
| Rifampicin | Strong CYP inducer; decreases etoricoxib plasma concentrations by ~65%. Consider dose adjustment or alternative therapy. | Moderate |