Etoricoxib

Etoricoxib is a selective cox-2 inhibitor nsaid (coxib) medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

Etoricoxib is used for:

• Osteoarthritis — usual dose 60 mg once daily
• Rheumatoid arthritis and ankylosing spondylitis — usually 90 mg once daily
• Acute gout attacks — 120 mg once daily for a maximum of 8 days
• Acute pain after dental surgery
• Other short-term musculoskeletal pain where a doctor judges a COX-2 inhibitor suitable

It relieves pain, swelling and stiffness but does not cure the underlying disease, which needs ongoing care from your doctor.

Etoricoxib is taken once daily, with or without food (taking with food may reduce stomach upset). Typical adult doses:

• 60 mg once daily for osteoarthritis
• 90 mg once daily for rheumatoid arthritis, ankylosing spondylitis or post-dental-surgery pain (short term)
• 120 mg once daily for acute gout — no longer than 8 days

Use the lowest effective dose for the shortest possible time. People with liver problems need reduced doses, and it is not recommended for children under 16. Your doctor will choose the dose after checking your blood pressure and heart and kidney health.

Common side effects of Etoricoxib include:

• Raised blood pressure — the most important one to watch
• Swollen ankles or legs from fluid retention
• Stomach discomfort, indigestion, nausea or diarrhoea
• Headache, dizziness or palpitations
• Raised liver enzymes on blood tests

Serious but less common: heart attack and stroke (risk rises with dose and duration), heart failure worsening, stomach ulcers and bleeding (less than older NSAIDs but not zero), kidney impairment and severe allergic or skin reactions. Seek urgent help for chest pain, one-sided weakness, black stools or severe breathlessness.

Key precautions with Etoricoxib:

• Check blood pressure before starting and regularly during treatment — etoricoxib can raise it; treatment should not start if BP is uncontrolled (above 140/90)
• Tell your doctor about any heart disease, stroke, clotting problems or strong family history before taking it
• Avoid in dengue fever or suspected dengue — paracetamol is the safe choice
• Use cautiously with kidney or liver disease, diabetes, smoking or high cholesterol
• Avoid when dehydrated
• Use the lowest dose for the shortest time; do not exceed 8 days at 120 mg for gout
• Do not combine with other NSAIDs

Important interactions of Etoricoxib:

• Warfarin — INR can rise; closer monitoring needed when starting or stopping
• ACE inhibitors, ARBs and diuretics — weaker blood-pressure control and risk of kidney injury
• Aspirin — low-dose cardiac aspirin may continue if prescribed, but ulcer risk rises; do not add other NSAIDs
• Lithium and methotrexate — blood levels and toxicity can increase
• Rifampicin — markedly lowers etoricoxib levels
• Oral contraceptives and hormone therapy — etoricoxib can raise hormone levels, increasing clot risk
• Ciclosporin, tacrolimus — increased kidney toxicity

Share your full medicine list with your doctor before starting.

Do not take Etoricoxib if you have:

• Established heart disease (previous heart attack, angina), stroke or peripheral arterial disease
• Uncontrolled high blood pressure (persistently above 140/90 mmHg)
• Moderate to severe heart failure
• Active peptic ulcer or gastrointestinal bleeding
• Severe kidney or liver impairment
• Asthma, hives or allergy triggered by aspirin or other NSAIDs
• Dengue fever or suspected dengue
• Pregnancy (especially the last trimester) and breastfeeding, unless a specialist advises otherwise
• Inflammatory bowel disease (active ulcerative colitis or Crohn's disease)

Pregnancy: Etoricoxib should not be used in pregnancy. Like other NSAIDs it is contraindicated in the third trimester because it can prematurely close a vessel in the baby's heart, impair the baby's kidneys and delay labour; it is also best avoided earlier in pregnancy and when trying to conceive, as COX-2 inhibitors may affect ovulation.

Breastfeeding: There is insufficient data on etoricoxib in human breast milk, so it is not recommended while breastfeeding. Ask your doctor for a safer, better-studied alternative.

Store Etoricoxib below 30°C in a cool, dry place, protected from light and moisture. Keep tablets in the original blister pack until use. Keep all medicines out of the reach and sight of children. Do not use after the expiry date printed on the pack.