What is the recommended dose of Etoricoxib (Arcoxia) for osteoarthritis, rheumatoid arthritis, and acute gouty arthritis?

Etoricoxib Dosing for Osteoarthritis, Rheumatoid Arthritis, and Acute Gouty Arthritis

For osteoarthritis, use etoricoxib 60 mg once daily; for rheumatoid arthritis, use 90 mg once daily; and for acute gouty arthritis, use 120 mg once daily. 1, 2, 3

Specific Dosing by Indication

Osteoarthritis

• Etoricoxib 60 mg once daily is the recommended dose for chronic treatment of osteoarthritis 1, 3, 4
• This dose provides sustained efficacy comparable to naproxen 500 mg twice daily over long-term treatment (up to 138 weeks) 4
• However, NICE guidelines specifically recommend against using etoricoxib 60 mg as first-choice COX-2 inhibitor for osteoarthritis, suggesting other COX-2 inhibitors or standard NSAIDs instead 5

Rheumatoid Arthritis

• Etoricoxib 90 mg once daily is the recommended dose for chronic treatment of rheumatoid arthritis 1, 3, 6
• This dose demonstrates sustained efficacy over 121 weeks of treatment, with effectiveness comparable to naproxen 500 mg twice daily 6
• The 90 mg dose provides rapid and sustained improvements in disease activity, tender/swollen joint counts, and patient assessment measures 6

Acute Gouty Arthritis

• Etoricoxib 120 mg once daily is the recommended dose for acute gout flares 1, 2, 3
• This is the highest approved daily dose and is specifically indicated for acute pain relief in gouty arthritis 1
• The American College of Rheumatology guidelines support the use of COX-2 inhibitors like etoricoxib at full anti-inflammatory doses for acute gout, though etoricoxib is not available in the United States 5
• Treatment should be initiated within 24 hours of symptom onset for optimal outcomes 7, 8

Critical Prescribing Principles

Duration and Dosing Strategy

• Use the lowest effective dose for the shortest possible duration to minimize gastrointestinal, hepatic, and cardiorenal toxicity 5
• The long plasma half-life of etoricoxib allows for convenient once-daily dosing 1
• For acute gouty arthritis, continue treatment until complete resolution of symptoms, typically 5-14 days 7

Gastrointestinal Protection

• Always co-prescribe a proton pump inhibitor when using etoricoxib, selecting the one with the lowest acquisition cost 5
• Etoricoxib demonstrates fewer uncomplicated upper gastrointestinal adverse events compared to nonselective NSAIDs 2

Cardiovascular Risk Assessment

• Carefully assess cardiovascular risk factors before prescribing, including uncontrolled hypertension 2
• Etoricoxib was noninferior to diclofenac in terms of thrombotic cardiovascular events, but all NSAIDs carry CV risk 2
• Weigh potential GI and CV risks against benefits in each individual patient 2

Common Pitfalls to Avoid

• Do not use etoricoxib 60 mg as the first-choice COX-2 inhibitor for osteoarthritis per NICE guidance; consider other COX-2 inhibitors or standard NSAIDs first 5
• Do not exceed recommended doses: 60 mg for OA, 90 mg for RA, 120 mg for acute gout 1, 3
• Do not prescribe without assessing age and comorbidities, particularly in elderly patients who require careful risk-benefit assessment 5
• Do not forget to continue urate-lowering therapy during an acute gout attack if the patient is already on it 7, 8