What is Etoricoxib (Arcoxia)

From the Guidelines

Etoricoxib should be used with caution due to its potential to increase the risk of thrombotic cardiovascular events, and its use should be carefully weighed against its benefits in patients with a history of heart disease, hypertension, or stroke. The medication is a nonsteroidal anti-inflammatory drug (NSAID) belonging to the COX-2 inhibitor class, used to treat pain and inflammation in conditions like osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and acute gout 1.

Key Points to Consider

• The typical dosage ranges from 60-120 mg once daily, with 60 mg commonly prescribed for osteoarthritis, 90 mg for rheumatoid arthritis and ankylosing spondylitis, and 120 mg for acute gout (limited to 8 days) 1.
• Etoricoxib works by selectively inhibiting the COX-2 enzyme, reducing inflammation and pain while potentially causing fewer gastrointestinal side effects than traditional NSAIDs 1.
• However, it still carries cardiovascular risks, particularly in patients with heart disease, hypertension, or stroke history, as it can produce a relative reduction in endothelial production of prostacyclin, while leaving the platelet production of TXA2 intact 1.
• Common side effects include stomach discomfort, headache, dizziness, and fluid retention 1.
• Etoricoxib should be taken with caution in patients with kidney or liver problems, and is contraindicated during pregnancy, especially the third trimester 1.
• The MEDAL program reported noninferiority of etoricoxib compared with diclofenac with regard to cardiovascular thrombotic (arterial and venous) events, but the hazard ratio for the primary composite end point of vascular death, myocardial infarction, or stroke through the end of follow-up was 1.02 (95% CI 0.87 to 1.18) 1.

Important Considerations

• The use of etoricoxib should be carefully monitored in patients with a history of cardiovascular disease, and alternative treatments should be considered when possible.
• Patients should be educated on the potential risks and benefits of etoricoxib, and should be instructed to report any signs or symptoms of cardiovascular events to their healthcare provider immediately.

From the FDA Drug Label

NSAID medicines can cause ulcers and bleeding in the stomach and intestines at any time during treatment Ulcers and bleeding: can happen without warning symptoms may cause death The chance of a person getting an ulcer or bleeding increases with: taking medicines called "corticosteroids" and "anticoagulants" longer use smoking drinking alcohol older age having poor health

• Etoricoxib is an NSAID medicine, and as such, it can cause ulcers and bleeding in the stomach and intestines at any time during treatment.
• The risk of ulcers and bleeding increases with longer use, smoking, drinking alcohol, older age, and having poor health.
• Etoricoxib should only be used exactly as prescribed, at the lowest dose possible, for the shortest time needed 2.

From the Research

Etoricoxib Overview

• Etoricoxib is a selective inhibitor of cyclooxygenase-2 (COX-2), an enzyme involved in pain and inflammation 3.
• It is a member of the COX-2-selective (coxib) class of nonsteroidal antiinflammatory drugs (NSAIDs) 3.
• Etoricoxib has been shown to have analgesic and antiinflammatory efficacy at least as good as, and in some cases superior to, nonselective NSAIDs in various disease and patient treatment settings 3, 4.

Indications and Dosage

• Etoricoxib is approved in several countries for 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 3.
• The recommended daily dose for chronic use is 90 mg for rheumatoid arthritis and 60 mg for osteoarthritis and chronic low back pain 3.
• The recommended daily dose for acute pain relief treatment from primary dysmenorrhea and acute gouty arthritis is 120 mg 3.

Safety and Tolerability

• Etoricoxib has been shown to have improved gastrointestinal safety compared to nonselective NSAIDs 3, 5.
• It has a favorable overall safety and tolerability profile, but may be associated with a higher risk of thrombotic cardiovascular events, particularly in patients with uncontrolled hypertension 4, 5.
• Etoricoxib is contraindicated in patients with ischaemic heart disease or stroke, and should be used with caution in patients with risk factors for heart disease 5.

Clinical Use

• Etoricoxib may be considered as a treatment option for patients requiring NSAID therapy, particularly those at risk of upper GI events 4.
• The potential GI and CV risks of treatment with etoricoxib should be weighed against the potential benefits in individual patients, and it should be administered at the lowest effective dose for as short a duration as possible 4, 6.
• Etoricoxib is a suitable option for patients with a low cardiovascular risk and a high risk of gastrointestinal complications 7.