Is there any difference between taking etoricoxib 120 mg once daily versus 60 mg twice daily?

Etoricoxib Dosing: Once Daily vs Twice Daily

Etoricoxib should only be administered as 120 mg once daily, not as 60 mg twice daily—the twice-daily regimen is not supported by pharmacokinetic data, has never been studied in clinical trials, and contradicts the drug's approved dosing schedule.

Pharmacokinetic Rationale

The pharmacokinetic profile of etoricoxib definitively supports once-daily dosing:

• Etoricoxib has an elimination half-life of approximately 20 hours in healthy subjects, which enables once-daily dosing 1
• The drug demonstrates proportional increases in plasma concentration (AUC) with oral doses between 5 and 120 mg, with moderate absorption reaching maximum plasma concentration after approximately 1 hour 1
• This extended half-life provides sustained therapeutic levels throughout a 24-hour period with a single daily dose 1

Approved Dosing Regimens

The established dosing for etoricoxib is strictly once-daily:

• For acute gouty arthritis, etoricoxib is indicated at 120 mg once daily for 8 days 2
• For osteoarthritis, the recommended dose is 60 mg once daily 3
• For rheumatoid arthritis, the recommended dose is 90 mg once daily 3

Clinical Trial Evidence

All major clinical trials have exclusively evaluated once-daily dosing:

• A randomized double-blind trial in Chinese patients with acute gout compared etoricoxib 120 mg once daily versus indometacin 75 mg twice daily, demonstrating comparable efficacy and safety 4
• Two 138-week studies in osteoarthritis patients used etoricoxib 60 mg once daily (not divided doses), showing sustained efficacy and tolerability 5
• A 6-week comparative study used etoricoxib 60 mg once daily versus diclofenac 50 mg three times daily, with etoricoxib demonstrating more rapid onset of benefit on day one 6

Critical Safety Considerations

Use etoricoxib at the lowest effective dose for the shortest possible duration, typically 2-4 weeks for active treatment phase 2:

• The American Heart Association states that etoricoxib does not appear to be among first choices for pain relief regarding safety, especially in individuals with or at risk for cardiovascular disease 2
• For patients with cardiovascular disease or high risk factors, use a stepped-care approach starting with acetaminophen, aspirin, tramadol, or narcotic analgesics before considering NSAIDs 2
• Evaluate treatment response at 2-4 weeks after initiation, and consider switching to on-demand treatment or dose tapering with sustained sufficient response at 12 weeks 2

Why Twice-Daily Dosing Is Inappropriate

There is no pharmacologic or clinical justification for splitting the 120 mg dose:

• The 20-hour half-life eliminates any need for twice-daily administration 1
• No clinical trials have evaluated 60 mg twice daily dosing for any indication 3, 4, 5, 6
• Dividing the dose would create unnecessary complexity without pharmacokinetic benefit and could reduce patient adherence

Common Pitfalls to Avoid

• Do not extrapolate twice-daily dosing from other NSAIDs (such as diclofenac or indometacin) to etoricoxib, as each drug has distinct pharmacokinetic properties 1
• Do not assume that splitting doses reduces adverse effects—the total daily exposure remains the same, and the extended half-life maintains continuous drug levels regardless of dosing frequency 1
• Do not continue etoricoxib beyond the acute treatment phase without reassessment—prolonged use increases cardiovascular and gastrointestinal risks 2