What is the correct dosing for etoricoxib (Arcoxia) for arthritis treatment?

Etoricoxib Dosing for Arthritis

For rheumatoid arthritis, etoricoxib should be dosed at 90 mg once daily, while for osteoarthritis, the recommended dose is 60 mg once daily. 1, 2

Dosing by Arthritis Type

Rheumatoid Arthritis

• Standard dose: 90 mg once daily 1, 2, 3
• This dose has been extensively validated in multiple randomized controlled trials showing efficacy comparable to naproxen 500 mg twice daily 3, 4
• The 90 mg dose demonstrated sustained efficacy over 121 weeks of continuous treatment 4
• While 60 mg daily also shows efficacy superior to placebo, the 90 mg dose provides statistically significant additional pain relief, though the clinical difference is modest 1

Osteoarthritis

• Standard dose: 60 mg once daily 2, 5
• This lower dose is appropriate given the generally less severe inflammatory component compared to rheumatoid arthritis 2
• The 60 mg dose demonstrated sustained efficacy over 138 weeks in long-term studies 5

Dose Escalation Considerations

Dose escalation from 60 mg to 90 mg in patients with inadequate pain relief is generally not recommended based on recent evidence 1:

• A 2016 randomized trial specifically evaluated whether increasing from 60 mg to 90 mg after 6 weeks improved outcomes in pain inadequate responders 1
• No significant improvement was observed with dose escalation compared to maintaining 60 mg 1
• If 60 mg provides insufficient relief in osteoarthritis, switching to an alternative therapeutic approach is more appropriate than dose escalation 1

Treatment Duration and Monitoring

Use etoricoxib at the lowest effective dose for the shortest possible duration, typically 2-4 weeks for the active treatment phase 6:

• Evaluate treatment response at 2-4 weeks after initiation 6
• With sustained sufficient response at 12 weeks, consider switching to on-demand treatment or dose tapering 6
• Long-term continuous use (beyond 12 weeks) should be reserved for patients with persistent active disease who have demonstrated clear benefit 4, 5

Critical Safety Considerations Before Prescribing

Absolute Contraindications

Do not prescribe etoricoxib in patients with 7:

• Established ischemic heart disease or cerebrovascular disease 7
• Active peptic ulcer disease or current gastrointestinal bleeding 7
• Severe renal impairment (eGFR <30 mL/min) 7
• Severe hepatic impairment 7

Pre-Treatment Risk Assessment Required

Evaluate cardiovascular risk factors before prescribing 7, 6:

• Etoricoxib is a highly selective COX-2 inhibitor with increased cardiovascular thrombotic event risk proportional to baseline patient risk 7, 6
• For patients with known cardiovascular disease or high-risk factors, consider alternative pain management first (acetaminophen, tramadol, or topical NSAIDs) 7
• Monitor blood pressure during treatment, as hypertension and edema are common side effects 7, 6

Gastroprotection Strategy

Co-prescribe a proton pump inhibitor for gastroprotection, particularly in patients with gastrointestinal risk factors 7:

• History of peptic ulcer disease (even if healed) 7
• Concomitant use of corticosteroids or SSRIs 7
• Elderly patients 7
• Helicobacter pylori infection (treat before initiating etoricoxib) 7

Common Pitfalls to Avoid

• Do not use the 120 mg dose for rheumatoid or osteoarthritis—this dose is reserved specifically for acute gout attacks (8 days maximum) 6, 2
• Do not assume etoricoxib is as safe as traditional NSAIDs in cardiovascular disease patients—it carries distinct cardiovascular risks due to COX-2 selectivity 7, 6
• Do not continue indefinitely without reassessment—evaluate response at 2-4 weeks and consider on-demand dosing or tapering at 12 weeks if response is sustained 6
• Do not prescribe without checking renal function in elderly patients—age increases risk for serious renal events 7