Overview
Etoricoxib is a selective cyclooxygenase-2 (COX-2) inhibitor, a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation management in various conditions. It provides analgesic and anti-inflammatory effects with potentially lower gastrointestinal risk compared to non-selective NSAIDs, though cardiovascular risks remain.
Mechanism of Action
Selectively inhibits cyclooxygenase-2 (COX-2) enzyme, reducing prostaglandin synthesis at sites of inflammation while sparing COX-1-mediated protective prostaglandins in the gastrointestinal tract.
Indications
- Osteoarthritis
- Rheumatoid arthritis
- Ankylosing spondylitis
- Acute gouty arthritis
- Chronic musculoskeletal pain
Dosage
Typically 60-120 mg once daily depending on indication. Maximum dose: 120 mg/day. Should be used at lowest effective dose for shortest duration.
Contraindications
- Hypersensitivity to etoricoxib or other NSAIDs
- Active peptic ulcer or GI bleeding
- Severe hepatic impairment
- Severe renal impairment
- Third trimester of pregnancy
- History of asthma, urticaria, or allergic reactions after taking aspirin or other NSAIDs
- Inflammatory bowel disease
- Congestive heart failure (NYHA Class II-IV)
- Established ischemic heart disease, peripheral arterial disease, or cerebrovascular disease
Side Effects
- Headache
- Dizziness
- Hypertension
- Edema
- Dyspepsia
- Abdominal pain
- Nausea
- Diarrhea
- Fatigue
- Elevated liver enzymes
- Upper respiratory tract infection
- Rash
- Increased risk of cardiovascular events
- Gastrointestinal bleeding
Interactions
- Warfarin (increased bleeding risk)
- Lithium (increased lithium levels)
- Methotrexate (increased methotrexate toxicity)
- ACE inhibitors/ARBs (reduced antihypertensive effect)
- Diuretics (reduced diuretic effect)
- Cyclosporine (increased nephrotoxicity)
- Rifampin (reduced etoricoxib levels)
- Other NSAIDs (increased GI toxicity)