etoricoxib

Etoricoxib is a non-steroidal anti-inflammatory drug (NSAID) that selectively inhibits the enzyme cyclooxygenase-2 (COX-2). It was developed as a COX-2–selective option to reduce inflammation and pain with a lower risk of gastrointestinal ulcers compared with nonselective NSAIDs. In many regions it is marketed under the brand name Arcoxia, but it is not approved for use in the United States.

Indications and dosing considerations vary by country and condition. Etoricoxib is used for relief of pain and symptoms associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. It is also used in some settings for acute painful gout and other inflammatory conditions. Dosing is typically tailored to the condition and patient response, often given as a once-daily tablet in the range of 60 to 120 mg, with higher doses used for short courses in certain indications. Treatment duration should follow clinical guidelines and be regularly reviewed.

Mechanism of action: By inhibiting COX-2, etoricoxib decreases the production of prostaglandins involved in inflammation, pain, and fever, while preserving most COX-1–mediated protective gastric functions to a greater extent than nonselective NSAIDs. This does not eliminate gastrointestinal, renal, or cardiovascular risks.

Safety and adverse effects: Common adverse effects include abdominal pain, nausea, edema, and hypertension. Serious risks include gastrointestinal bleeding, liver or kidney injury, cardiovascular events, and allergic reactions. It should be avoided in patients with active GI ulcers or bleeding, significant hepatic or renal impairment, uncontrolled hypertension, or known NSAID sensitivity. Use in pregnancy is generally avoided, particularly in later trimesters.

Pharmacokinetics and interactions: Etoricoxib is taken orally, with peak concentrations reached within a few hours and a long elimination half-life that supports once-daily dosing. It is primarily metabolized in the liver. Potential interactions exist with anticoagulants, antihypertensives, diuretics, and other NSAIDs; concurrent use with other NSAIDs is usually avoided.