Etoricoxib Should Not Be Used to Treat Cough
Etoricoxib (Arcoxia) is a selective COX-2 inhibitor indicated for pain and inflammation from arthritis, musculoskeletal conditions, and acute pain syndromes—it has no role in treating cough and is not recommended for this indication. 1, 2
Why Etoricoxib Is Not Appropriate for Cough
Mechanism and Approved Indications
- Etoricoxib selectively inhibits cyclooxygenase-2 (COX-2), an enzyme involved in pain and inflammation pathways, not cough reflex pathways 1
- Approved indications include osteoarthritis, rheumatoid arthritis, acute gouty arthritis, chronic low back pain, primary dysmenorrhea, and acute pain—none of which include cough 1, 3
- The drug works through anti-inflammatory and analgesic mechanisms that do not address the neurological cough reflex or airway irritation that causes cough 2
Lack of Evidence for Cough Treatment
- No clinical guidelines for cough management (including comprehensive ACCP and Thorax guidelines) recommend COX-2 inhibitors or NSAIDs for treating cough 4
- The only reported use of etoricoxib related to cough is for secondary cough headache (headache triggered by coughing), not for treating the cough itself 5
Evidence-Based Treatments for Cough Instead
For Acute Nonproductive Dry Cough
- Dextromethorphan is first-line treatment with maximum suppression at 60 mg, providing substantial benefit with favorable safety 6
- Simple remedies like honey and lemon mixtures, adequate hydration, and menthol lozenges provide symptomatic relief 6
- Codeine may be used for short-term relief but has more side effects than dextromethorphan 6
For Chronic Cough with Sputum Production (Chronic Bronchitis)
- Ipratropium bromide 36 μg (2 inhalations) four times daily is first-line therapy with Grade A evidence, reducing cough frequency and sputum volume 7
- Short-acting β-agonists can be added as second-line therapy 7
- Central antitussives like codeine or dextromethorphan reduce cough counts by 40-60% for severe paroxysms 4, 7
For Chronic Cough Requiring Systematic Evaluation
- A systematic diagnostic approach is essential, evaluating for asthma, gastroesophageal reflux disease (GERD), upper airway cough syndrome, and ACE inhibitor use 4
- Chest radiograph and spirometry are mandatory initial investigations 4
- Treatment should target the underlying cause: inhaled corticosteroids for eosinophilic airway disease, proton pump inhibitors for GERD, or topical nasal corticosteroids for rhinosinusitis 4
For Refractory Chronic Cough
- Neuromodulators like gabapentin and multimodality speech pathology therapy are recommended 4
- Opiates may be used for palliative symptom control when alternative treatments fail and cough severely affects quality of life 4
Key Clinical Pitfall
The most important pitfall is using anti-inflammatory drugs like etoricoxib for cough when they have no mechanism of action on cough pathways and no evidence of efficacy. This delays appropriate diagnosis and treatment of the underlying cause while exposing patients to unnecessary cardiovascular and renal risks associated with COX-2 inhibitors 2, 3.