Etoricoxib

Oral
Ankylosing spondylitis, Rheumatoid arthritis

Oral
Osteoarthritis

Oral
Acute gouty arthritis

Oral
Pain and inflammation associated with dental surgery

CrCl (mL/min)	Dosage
<30	Contraindicated.

Mild (Child-Pugh score 5-6): Max: 60 mg once daily. Moderate (Child-Pugh score 7-9): Max: 30 mg once daily. Severe (Child-Pugh score ≥10): Contraindicated.

May be taken with or without food.

Hypersensitivity. Patient with active peptic ulceration or gastrointestinal bleeding, inflammatory bowel disease, congestive heart failure (NYHA II-IV), uncontrolled hypertension or with persistently high blood pressure (>140/90 mmHg), ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, history of bronchospasm, acute rhinitis, nasal polyps, angioneurotic oedema, urticaria or allergic-type reactions after taking aspirin, NSAIDs including COX-2 inhibitors. Children and adolescent <16 years. Renal (CrCl <30 mL/min) and severe hepatic (Child-Pugh ≥10) impairment. Pregnancy.

Patient with history of gastrointestinal disease (e.g. ulceration, gastrointestinal bleeding), with risk factors for cardiovascular events (e.g. hyperlipidaemia, hypertension, diabetes mellitus, smoking), uncompensated heart failure, cirrhosis, history of cardiac failure, left ventricular dysfunction, pre-existing oedema, dehydration. Mild to moderate hepatic impairment. Elderly. Lactation.

Significant: Fluid retention, oedema, hypertension, increased ALT or AST, hypersensitivity reactions including anaphylaxis and angioedema.
Cardiac disorders: Palpitations, arrhythmia.
Gastrointestinal disorders: Abdominal pain, constipation, flatulence, gastritis, heartburn, diarrhoea, dyspepsia, nausea, vomiting, oesophagitis, oral ulcer.
General disorders and admin site conditions: Asthenia, flu-like disease.
Infections and infestations: Alveolar osteitis.
Nervous system disorders: Headache.
Respiratory, thoracic and mediastinal disorders: Bronchospasm.
Potentially Fatal: Gastrointestinal perforations, ulcers or bleedings, exfoliative dermatitis, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN).

PO: Z (NSAIDs caused foetal ductus arteriosus premature closure, foetal renal impairment and persistent pulmonary hypertension. Avoid near term, else use lowest dose for shortest time.)

This drug may cause dizziness, vertigo or somnolence, if affected, do not drive or operate machinery.

Monitor blood pressure prior to and during therapy, and periodically thereafter.

Symptoms: Gastrointestinal events, cardiorenal events. Management: Supportive treatment e.g. removal of unabsorbed drug from the gastrointestinal tract and clinical monitoring.

Increased INR with anticoagulants (e.g. warfarin). May decrease effect of diuretics and antihypertensive agents. Concomitant use with ACE inhibitor or angiotensin II antagonist may further deteriorate renal function. May increase rate of gastrointestinal ulceration with concomitant low dose acetylsalicylic acid. Increased plasma concentrations of ethinylestradiol, lithium, methotrexate, and other drugs metabolised by human sulfotransferases (e.g. oral salbutamol, minoxidil). Decreased plasma concentrations with rifampicin.

Description: Etoricoxib, an NSAID, is a selective cyclo-oxygenase-2 (COX-2) inhibitor. Its anti-inflammatory and analgesic action is exhibited by inhibition of prostaglandin synthesis via inhibition of COX-2.
Pharmacokinetics:
Absorption: Well absorbed from the gastrointestinal tract, food delays rate of absorption. Absolute bioavailability: Approx 100%. Time to peak plasma concentrations: Approx 1 hour (without food), 2 hours (with food).
Distribution: Volume of distribution: 120 L. Plasma protein binding: Approx 92%.
Metabolism: Extensively metabolised via CYP3A4 isoenzyme to form 6’-hydroxymethyl derivative of etoricoxib, then oxidised to 6’-carboxylic acid derivative (major metabolite).
Excretion: Mainly via urine (70%), 20% in faeces, <2% as unchanged drug. Elimination half-life: Approx 22 hours.

Source: National Center for Biotechnology Information. PubChem Database. Etoricoxib, CID=123619, https://pubchem.ncbi.nlm.nih.gov/compound/Etoricoxib (accessed on Jan. 23, 2020)

Store below 30°C.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

M01AH05 - etoricoxib ; Belongs to the class of non-steroidal antiinflammatory and antirheumatic products, coxibs.

Anon. Etoricoxib. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 10/04/2019.

Auxib 30 mg Film-Coated Tablets (Merck Sharp & Dohme Limited). MHRA. https://products.mhra.gov.uk/. Accessed 03/05/2019.

Buckingham R (ed). Etoricoxib. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.new.medicinescomplete.com. Accessed 14/05/2014.

Joint Formulary Committee. Etoricoxib. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 14/05/2014.