Maximum Dose of Etoricoxib
The maximum recommended dose of etoricoxib is 120 mg once daily, used for acute gouty arthritis, with lower doses of 60 mg/day for osteoarthritis and 90 mg/day for rheumatoid arthritis. 1, 2
Dose-Specific Recommendations by Indication
- Osteoarthritis: 60 mg once daily 2
- Rheumatoid arthritis: 90 mg once daily 2
- Acute gouty arthritis: 120 mg once daily for 8 days 1, 2
- Acute postoperative pain: 120 mg single dose has been studied, with higher doses of 180-240 mg showing efficacy but not being standard recommendations 3
Duration of Treatment
Etoricoxib should be used at the lowest effective dose for the shortest possible duration, typically 2-4 weeks for the active treatment phase. 1
- For chronic inflammatory conditions, evaluate treatment response at 2-4 weeks after initiation 1
- With sustained sufficient response at 12 weeks, consider switching to on-demand treatment or dose tapering 1
- For acute gout, limit treatment to 8 days at 120 mg/day 1
- Short-term use (2-4 weeks) minimizes cardiovascular, gastrointestinal, and renal risks 1
Critical Safety Considerations
Etoricoxib has high COX-2 selectivity, which increases thrombotic cardiovascular event risk proportional to the patient's baseline cardiovascular risk. 4
- The American Heart Association explicitly states that etoricoxib does not appear to be among the first choices for pain relief with regard to safety, especially in individuals with or at risk for cardiovascular disease 4
- For patients with known cardiovascular disease or high risk factors, consider alternative pain management options such as acetaminophen, tramadol, or short-term narcotic analgesics 1, 4
- Etoricoxib should be used with caution in patients with risk factors for cardiovascular, renal, or gastrointestinal adverse effects 1
Pharmacokinetic Profile Supporting Once-Daily Dosing
- Etoricoxib has an elimination half-life of approximately 20 hours, enabling once-daily dosing 5
- The area under the plasma concentration-time curve increases proportionally with oral doses between 5 and 120 mg 5
- Maximum plasma concentration occurs after approximately 1 hour 5
Common Pitfalls to Avoid
- Never assume etoricoxib is safer than traditional NSAIDs due to its high COX-2 selectivity and associated cardiovascular risk 4
- Do not ignore cardiovascular risk stratification before prescribing, particularly in patients over 60 years or those with cardiovascular disease history 1, 4
- Avoid extended courses beyond 2-4 weeks without clear evidence of continued benefit and absence of adverse events 1
- Monitor blood pressure, renal function, and liver function for patients requiring long-term pain management 1