From the Guidelines
Etoricoxib is a selective COX-2 inhibitor that should be used with caution due to its potential cardiovascular risks, and its use is not recommended in patients with heart failure, as stated in the 2016 ESC guidelines 1. Etoricoxib is a medication used to treat pain and inflammation in conditions like osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and acute gout. It's typically prescribed at doses ranging from 30-120 mg once daily, with the specific dose depending on the condition being treated.
- Etoricoxib works by selectively blocking the cyclooxygenase-2 (COX-2) enzyme, which is responsible for producing inflammatory prostaglandins, while largely sparing the COX-1 enzyme that protects the stomach lining.
- This selective action gives etoricoxib an advantage over traditional NSAIDs by potentially causing fewer gastrointestinal side effects. However, like other COX-2 inhibitors, it carries cardiovascular risks, as noted in several studies, including those published in Circulation 1 and Annals of the Rheumatic Diseases 1.
- Common side effects include headache, dizziness, and gastrointestinal disturbances.
- Etoricoxib is contraindicated in patients with severe heart failure, active peptic ulceration, or inflammatory bowel disease, and should be used at the lowest effective dose for the shortest duration necessary to control symptoms, as recommended in the American Family Physician 1. The most recent and highest quality study, the 2016 ESC guidelines 1, emphasizes the importance of caution when using etoricoxib in patients with cardiovascular risk factors, and recommends against its use in patients with heart failure.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Definition and Mechanism of Action
- Etoricoxib is a selective inhibitor of cyclooxygenase-2 (COX-2), an enzyme involved in pain and inflammation 2.
- It is a member of the COX-2-selective (coxib) class of nonsteroidal antiinflammatory drugs (NSAIDs) 2.
Therapeutic Uses
- Etoricoxib is approved for various indications including the treatment of acute pain, acute gouty arthritis, chronic low back pain, primary dysmenorrhea, and chronic treatment for the signs and symptoms of osteoarthritis and rheumatoid arthritis 2.
- It has been evaluated for the treatment of rheumatoid arthritis in a double-blind, randomized controlled trial, demonstrating efficacy in relieving symptoms of RA 3.
Pharmacokinetics and Pharmacodynamics
- Etoricoxib is rapidly and completely absorbed following oral administration, providing a rapid onset of action 2.
- It has a long plasma half-life, allowing for once-daily dosing 2, 4.
- Etoricoxib is extensively protein bound, primarily to plasma albumin, and has an apparent volume of distribution of 120 L in humans 4.
- The elimination half-life of approximately 20 hours in healthy subjects enables once-daily dosing 4.
Efficacy and Safety
- Etoricoxib has demonstrated efficacy in the treatment of various conditions, including osteoarthritis, rheumatoid arthritis, and acute gouty arthritis 2, 3, 5.
- It has shown a significant reduction in gastrointestinal toxicity compared with many traditional NSAIDs 5, 4.
- The renal adverse effects of etoricoxib appear to be similar to those of other NSAIDs, and the cardiovascular adverse effects of this selective COX-2 inhibitor require further clinical scrutiny 4.