From the Guidelines
Etoricoxib should be used with caution due to its potential cardiovascular risks, including increased risk of heart attack and stroke, especially with prolonged use or in patients with pre-existing cardiovascular disease. Etoricoxib is a nonsteroidal anti-inflammatory drug (NSAID) that selectively inhibits cyclooxygenase-2 (COX-2), used primarily to treat pain and inflammation associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and acute gout. 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 for gout) 1. Patients should take etoricoxib with or without food, at the same time each day. Unlike traditional NSAIDs, etoricoxib causes less gastrointestinal irritation due to its COX-2 selectivity, making it potentially safer for patients with a history of peptic ulcers. However, the MEDAL program, which randomized 34,701 patients with either rheumatoid arthritis or osteoarthritis to either etoricoxib or diclofenac, reported a hazard ratio for the primary composite end point of vascular death, myocardial infarction, or stroke through the end of follow-up of 1.02 (95% CI 0.87 to 1.18) 1.
Some key points to consider when prescribing etoricoxib include:
- Monitoring blood pressure regularly during treatment
- Avoiding use in patients with severe heart failure, active peptic ulceration, inflammatory bowel disease, and during the third trimester of pregnancy
- Being aware of common side effects, including headache, dizziness, hypertension, and edema
- Considering alternative treatment options for patients with pre-existing cardiovascular disease or those at high risk of cardiovascular events. The use of etoricoxib should be individualized, taking into account the patient's medical history, current health status, and potential risks and benefits 1.
From the Research
Etoricoxib Overview
- Etoricoxib is a selective inhibitor of cyclooxygenase-2 (COX-2), an enzyme involved in pain and inflammation 2.
- It is a member of the COX-2-selective (coxib) class of nonsteroidal antiinflammatory drugs (NSAIDs) 2.
- 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 2, 3, 4.
Indications and Dosage
- Etoricoxib is approved for various indications, including 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 2, 3, 4.
- The recommended daily dose for chronic use is 90 mg for rheumatoid arthritis and 60 mg for osteoarthritis and chronic low back pain 2, 4.
- The recommended daily dose for acute pain relief treatment from primary dysmenorrhea and acute gouty arthritis is 120 mg 2, 4.
Safety and Tolerability
- Etoricoxib has been shown to have improved gastrointestinal safety compared with nonselective NSAIDs 2, 3, 4.
- 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 3, 5, 6.
- 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, 6.