What is the recommended dosage and administration protocol for Etoricoxib in patients with osteoarthritis or rheumatoid arthritis, considering renal and liver function?

Etoricoxib Administration

Etoricoxib should be administered orally once daily at 60 mg for osteoarthritis, 90 mg for rheumatoid arthritis, and 120 mg for acute gouty arthritis, with no dose adjustment required for mild-to-moderate hepatic or renal impairment, though caution is warranted in severe dysfunction. 1

Standard Dosing by Indication

Osteoarthritis

• Administer 60 mg once daily 1, 2
• This dose has demonstrated sustained efficacy over 138 weeks of continuous treatment 2
• Clinical improvements are maintained long-term with consistent once-daily dosing 2

Rheumatoid Arthritis

• Administer 90 mg once daily 1, 3
• This dose provides comparable efficacy to naproxen 500 mg twice daily 3
• Sustained therapeutic benefit is maintained for at least 121 weeks of treatment 3

Acute Gouty Arthritis

• Administer 120 mg once daily 1
• This higher dose is specifically indicated for acute flares 1

Administration Considerations

Route and Timing

• Oral administration only - tablets are available in 60 mg, 90 mg, and 120 mg strengths 1
• Once-daily dosing simplifies adherence compared to twice-daily traditional NSAIDs 1, 3
• Can be taken with or without food (standard NSAID practice)

Renal Function

• No specific dose adjustment is mandated for mild-to-moderate renal impairment based on available evidence 4
• Exercise caution in severe renal dysfunction, as with all NSAIDs, though specific etoricoxib guidance in severe renal disease is limited in the provided evidence
• Monitor for fluid retention and worsening renal function, particularly in elderly patients 4

Hepatic Function

• No specific dose adjustment is required for mild-to-moderate hepatic impairment based on available evidence 4
• Use caution in severe hepatic dysfunction, though specific dosing guidance is not provided in the evidence
• The drug has been studied extensively without specific hepatic dosing restrictions in large trials 4, 2

Safety Monitoring

Cardiovascular Risk

• Cardiovascular thrombotic event rates with etoricoxib are similar to diclofenac (1.24 vs 1.30 per 100 patient-years) 4
• This represents comparable cardiovascular risk to traditional NSAIDs rather than increased risk 4
• Consider baseline cardiovascular risk assessment before initiating therapy 4

Gastrointestinal Safety

• Upper GI clinical events occur less frequently with etoricoxib (0.67 per 100 patient-years) compared to diclofenac (0.97 per 100 patient-years) 4
• Complicated upper GI events show similar rates between etoricoxib and traditional NSAIDs 4
• In inflammatory bowel disease patients, etoricoxib appears safe with only 10.5% experiencing disease flare-up, similar to placebo (11.4%) 5

Special Populations

• IBD patients can generally use etoricoxib safely - 89.5% of IBD patients completed 3 months of therapy without disease aggravation 5
• Flare-ups, when they occur, typically happen within the first month and are reversible upon discontinuation 5
• Traditional NSAIDs caused IBD flares in 88% of these same patients, making etoricoxib a safer alternative 5

Common Pitfalls to Avoid

• Do not exceed recommended doses - 60 mg for OA, 90 mg for RA, 120 mg for acute gout 1
• Do not use twice-daily dosing - etoricoxib is formulated for once-daily administration only 1, 3
• Do not assume contraindication in IBD - unlike traditional NSAIDs, etoricoxib shows acceptable safety in this population 5
• Do not overlook cardiovascular risk factors - while not worse than traditional NSAIDs, COX-2 inhibitors still carry cardiovascular considerations 4