What is a suitable alternative to Etoricoxib (Arcoxia) for a patient in Canada?

From the Guidelines

Celecoxib (Celebrex) is a suitable alternative to Etoricoxib (Arcoxia) for patients in Canada, with a recommended dose of 200-400 mg/day in divided doses, as per the expert consensus recommendations for the diagnosis and treatment of chronic non-bacterial osteitis (CNO) in adults 1. The key consideration in selecting an alternative to Etoricoxib is to choose a medication that belongs to the same class of COX-2 selective NSAIDs, which have a similar mechanism of action and potentially fewer gastrointestinal side effects compared to traditional NSAIDs.

• Other alternatives include:
  • Naproxen 375−1100 mg/day in two doses
  • Diclofenac starting at 150 mg/day in divided doses, maintenance 75−100 mg/day in divided doses
  • Indomethacin 150 mg/day in divided doses
  • Ibuprofen 1800 mg/day in divided doses
  • Piroxicam 20 mg/day in one dose
  • Meloxicam 15 mg/day in one dose, as listed in Table 6 of the expert consensus recommendations 1. It is essential to note that Etoricoxib is not approved for use in Canada, whereas these alternative medications are widely available.
• When prescribing any of these medications, it is crucial to consider the patient's medical history, potential drug interactions, and the lowest effective dose for the shortest duration necessary to minimize cardiovascular risks and other side effects, as recommended by the expert consensus 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Etoricoxib Alternatives in Canada

• Etoricoxib (Arcoxia) is a selective cyclo-oxygenase (COX)-2 inhibitor used for symptomatic relief in osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis 2, 3.
• A suitable alternative to Etoricoxib in Canada could be Celecoxib (Celebrex), which is also a COX-2 selective inhibitor 4.
• Celecoxib has been shown to be effective in the symptomatic treatment of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis, with a lower incidence of upper GI ulcer complications compared to nonselective NSAIDs 4.

Dosage and Efficacy

• The recommended dosage of Etoricoxib is 60 mg/day for osteoarthritis, 90 mg/day for rheumatoid arthritis, and 120 mg/day for acute gouty arthritis 2, 5.
• Celecoxib, on the other hand, is recommended at a dosage of 200 or 400 mg/day for the symptomatic treatment of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis 4.
• Studies have shown that Celecoxib is at least as effective as Etoricoxib in providing symptomatic relief for these conditions 4, 3.

Safety and Tolerability

• Both Etoricoxib and Celecoxib have been shown to have a favorable safety and tolerability profile, with a lower incidence of upper GI adverse events compared to nonselective NSAIDs 4, 2, 3.
• However, the potential GI and CV risks of treatment with these medications should be weighed against the potential benefits in individual patients, and they should be administered at the lowest effective dose for as short a duration as possible 4, 3.