Etoricoxib Should Be Avoided During Breastfeeding
Etoricoxib (Arcoxia) should be avoided in breastfeeding women due to insufficient safety data, and you should prescribe safer NSAID alternatives with established safety profiles instead. 1
Why Etoricoxib Is Not Recommended
The 2025 EULAR guidelines explicitly list etoricoxib among drugs that should be avoided during breastfeeding. 1 Importantly, this recommendation is based on insufficient data rather than documented evidence of infant harm—meaning we simply don't know enough about its safety profile to recommend its use when safer alternatives exist. 1
Safer NSAID Alternatives You Should Use Instead
First-Line Option
- Ibuprofen is the preferred choice for breastfeeding women, with the most extensive safety data and reassuring evidence available. 2 Use the lowest effective dose for the shortest duration necessary. 2
Second-Line Options
- Diclofenac has small amounts detected in breast milk but is considered safe during breastfeeding. 2
- Naproxen is widely used after cesarean section with normal breastfeeding, despite its longer half-life. 2
COX-2 Inhibitor Alternative
- Celecoxib (another COX-2 inhibitor like etoricoxib) has very low relative infant dose via milk and is explicitly compatible with breastfeeding. 2 This is particularly relevant since celecoxib provides similar COX-2 selectivity to etoricoxib but with established safety data.
Clinical Decision Algorithm
Step 1: For routine pain/inflammation in breastfeeding women, prescribe ibuprofen as first-line therapy. 2
Step 2: If additional analgesia is needed, combine ibuprofen with paracetamol (acetaminophen) for multimodal analgesia, which reduces total NSAID exposure. 2 Paracetamol is safe during breastfeeding, with infant ingestion via breast milk significantly less than pediatric therapeutic doses. 2
Step 3: If a COX-2 inhibitor is specifically indicated (e.g., for GI protection), use celecoxib instead of etoricoxib. 2
Step 4: Use the lowest effective dose for the shortest duration with any NSAID choice. 2
Important Caveats and Monitoring
- Infants under 6 weeks of age require extra caution when mothers use NSAIDs due to immature hepatic and renal function, though adverse effects remain rare. 2
- Observe infants for unusual behavioral changes, though adverse effects with NSAIDs are extremely rare. 2
- Do not unnecessarily discontinue breastfeeding—the benefits of continued breastfeeding outweigh theoretical minimal drug exposure risks with safe NSAIDs. 2
Common Pitfalls to Avoid
- Don't prescribe etoricoxib simply because it worked well during pregnancy—drugs safe in pregnancy may not be safe during lactation. 1
- Don't recommend "pump and dump"—this is not evidence-based for NSAID use and unnecessarily disrupts breastfeeding. 2
- Don't default to opioids as an alternative—they carry significantly higher risks of infant sedation and drowsiness compared to NSAIDs. 2