From the Guidelines
Etoricoxib is associated with an increased risk of cardiovascular events, including heart block, particularly in patients with pre-existing heart conditions, as evidenced by the study published in Circulation 1. The medication works by inhibiting the COX-2 enzyme, which reduces inflammation but can also disrupt the balance of substances that maintain normal heart rhythm and blood vessel function. Key points to consider include:
- The risk is dose-dependent and increases with longer duration of use
- Patients with existing cardiovascular disease, hypertension, or risk factors like diabetes are at higher risk for these complications
- If you're taking etoricoxib and experience symptoms such as dizziness, fainting, unusual fatigue, or irregular heartbeat, seek immediate medical attention
- Always use the lowest effective dose for the shortest duration possible to minimize cardiovascular risks
- Before starting etoricoxib, inform your healthcare provider about any heart conditions or risk factors you may have The MEDAL program, which randomized 34,701 patients with either rheumatoid arthritis or osteoarthritis to either etoricoxib or diclofenac, reported noninferiority of etoricoxib compared with diclofenac with regard to cardiovascular thrombotic events 1. However, clinicians are cautioned against concluding that etoricoxib is as safe as “traditional” NSAIDs, as both etoricoxib and diclofenac have been associated with an increased risk of thrombotic events 1. Therefore, it is essential to weigh the benefits and risks of etoricoxib and consider alternative treatment options, especially in individuals with or at risk for cardiovascular disease.
From the Research
Correlation between Etoricoxib and Heart Block
- There is no direct evidence of a correlation between etoricoxib and heart block in the provided studies.
- However, studies have shown that COX-2 inhibitors, including etoricoxib, may increase the risk of cardiovascular events such as myocardial infarction and stroke 2, 3, 4, 5.
- A meta-analysis of observational studies found that etoricoxib was associated with a higher cardiovascular risk (RR, 1.27 [95%CI, 1.12-1.43]) compared to other NSAIDs 5.
- Another study found that COX-2 inhibitors, including etoricoxib, may increase blood pressure, which can lead to an increased risk of cardiovascular morbidity 3.
- It is recommended that clinicians consider the potential cardiovascular risks associated with etoricoxib and other COX-2 inhibitors when prescribing these medications, especially for patients with pre-existing cardiovascular risk factors 2, 6.