From the Research
No dosage adjustment is required for etoricoxib (Arcoxia) in patients with mild to moderate renal impairment (creatinine clearance ≥30 mL/min), as the pharmacokinetics of etoricoxib are not significantly affected by renal impairment 1. However, etoricoxib is not recommended for patients with severe renal impairment (creatinine clearance <30 mL/min) due to limited clinical experience in this population and the potential for reduced drug clearance. Patients with renal impairment may be at increased risk for fluid retention and edema with etoricoxib, as the drug is a selective COX-2 inhibitor that can affect renal prostaglandins involved in maintaining kidney function. These prostaglandins help regulate renal blood flow, glomerular filtration rate, and sodium excretion. When prescribing etoricoxib to patients with renal impairment, it's essential to monitor kidney function, blood pressure, and signs of fluid retention, especially in elderly patients or those taking diuretics or ACE inhibitors concurrently. Starting with the lowest effective dose may be prudent in patients with borderline renal function. Some studies have shown that etoricoxib has a low risk of renal adverse effects, including hypertension, lower-extremity edema, elevated serum creatinine concentration, and congestive heart failure, compared to other nonsteroidal anti-inflammatory drugs (NSAIDs) 2. Additionally, etoricoxib has been shown to have no significant effect on urinary sodium excretion, creatinine clearance, or serum electrolytes in elderly subjects consuming a controlled sodium diet 3. It's crucial to prioritize the patient's overall health and adjust the treatment plan accordingly, taking into account the potential risks and benefits of etoricoxib in patients with renal impairment. The most recent and highest quality study on this topic is from 2004, which provides the most reliable guidance for clinical practice 1.