etoricoxib: clinical use

Prescribing considerations

• Assess cardiovascular, gastrointestinal, renal, hepatic and fluid-retention risks and periodically review symptomatic benefit.
• Control hypertension before initiation; use particular caution with cardiovascular risk factors, dehydration, previous gastrointestinal disease and older age.
• Etoricoxib can mask fever and other signs of inflammation and has no antiplatelet role.

Contraindications and cautions

• Hypersensitivity to etoricoxib, its excipients, aspirin or another NSAID with an allergic-type reaction
• Active peptic ulceration or gastrointestinal bleeding
• Pregnancy or breastfeeding under the product licence
• Severe hepatic dysfunction or severe renal impairment
• Age under 16 years
• Inflammatory bowel disease
• Congestive heart failure
• Persistently inadequately controlled hypertension
• Established ischaemic heart disease, peripheral arterial disease or cerebrovascular disease

Monitoring

• Check blood pressure soon after initiation and periodically thereafter.
• Consider renal function monitoring in older, dehydrated or renally vulnerable patients and with interacting medicines.
• Monitor liver function when clinically indicated; discontinue assessment is required for persistent marked abnormalities or hepatic symptoms.
• Monitor INR closely when used with warfarin or another oral anticoagulant.

Clinical pharmacology

Etoricoxib is an oral selective COX-2 inhibitor. It is highly protein-bound, extensively metabolised—partly through CYP3A4—and eliminated mainly as metabolites through urine and faeces; it does not inhibit platelet function.

Formulation and product differences

• The selected product consists of film-coated oral tablets whose colour and markings differ by strength.
• The tablets contain lactose and are essentially sodium-free.
• Blisters should remain in their original packaging, and bottles should be kept tightly closed to protect the tablets from moisture.

Tablet

Route: Oral

Strengths: 30 mg, 60 mg, 90 mg, 120 mg, 90120 mg