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What is Etoricoxib?

Etoricoxib is a painkiller primarily used for its analgesic and anti-inflammatory effects. The FDA approved it in 2004. But it was subsequently withdrawn from the US market in 2007 due to increased risk of cardiovascular diseases. However, Etoricoxib is now approved across 60 countries, including India, for treating arthritis, chronic back pain, and other acute pain (e.g., dental pain).
Etoricoxib is a selective cyclo-oxygenase enzyme (COX-2) inhibitor that reduces the production of prostaglandins from arachidonic acid. Prostaglandins affect our physiological processes, such as inflammation and blood flow. Thus, Etoricoxib breaks the pain pathway.
Etoricoxib is marketed as a newer non-steroidal anti-inflammatory drug (NSAID), similar to Ibuprofen to manage musculoskeletal pain.

What are the uses of Etoricoxib?

Etoricoxib is used for long-term treatment (taken for 3-months and more) and short-term treatment (taken for 1 to 3 weeks). It is used to manage pain in the following ways:

  • In conditions like osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis, Etoricoxib is prescribed to reduce pain and swelling in the joints and muscles for long-term treatment. Its clinical trials have shown a comparatively better safety profile and tolerance than Ibuprofen.
  • Etoricoxib is also used for treating pain following dental surgery in the short term.
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What are the side effects of Etoricoxib?

Etoricoxib came under the regulators’ lens due to various clinical trials reporting a higher risk of adverse cardiovascular events. However, the evidence was not conclusive. It could not prove that Etoricoxib caused a higher risk of blood clotting or hypertension-related adverse effects when compared to other NSAIDs like Diclofenac and Ibuprofen.

Etoricoxib’s common side effects are:

  • Stomach pain.
  • Constipation.
  • Swelling of the legs.
  • Irregular heartbeat and rhythm.
  • Increased blood pressure.
  • Mouth ulcers.

Less commonly noted side effects can be shortness of breath, heartburn, and inflammation of the inner lining of the stomach and intestine.

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FAQ's

1. Can you take naproxen with Etoricoxib?

Etoricoxib and naproxen are selective COX-2 inhibitors that follow identical mechanisms of action. Therefore, do not take naproxen with Etoricoxib. A comparative study demonstrated that Etoricoxib resulted in better pain management and lesser side effects than naproxen. Don't take Etoricoxib or naproxen unless a registered medical practitioner prescribes it.

2. Is Etoricoxib safe in pregnancy?

Pregnant women, women planning to become pregnant, or breastfeeding mothers are discouraged from taking Etoricoxib. While human studies have been inconclusive, animal studies have shown that COX-2 inhibitors like Etoricoxib show reproductive toxicity. Nursing animals were proven to secrete the drug in breast milk, which would affect prostaglandin production in infants. Therefore, consult your doctor if you are already taking Etoricoxib and planning to become pregnant.

3. How to take Etoricoxib?

Etoricoxib is available as tablets with concentrations of 30mg, 60mg, 90mg, and 120mg. Etoricoxib intramuscular injections are available in 90mg concentration. It is generally prescribed as a once-daily dose and can be taken on an empty stomach or after meals. However, it provides much quicker relief from pain and swelling when taken on an empty stomach.

4. Can Etoricoxib cause high blood pressure?

Increased blood pressure is a common side effect associated with Etoricoxib. A study conducted on Australian patients concluded that Etoricoxib should not be prescribed to patients with blood pressure levels above 140/90 mm of Hg. Compared with other NSAIDs like Diclofenac and Celecoxib, Etoricoxib was associated with a significantly higher risk of increased blood pressure.

5. Can I take Etoricoxib with Paracetamol?

Etoricoxib can be taken with paracetamol, as Etoricoxib is anti-inflammatory and paracetamol reduces fever. Together, they prevent the release of chemicals in the brain that cause pain and fever. This combination should be sold only when a registered medical practitioner prescribes it, as side effects like stomach problems and feet and hand swelling are possible.

6. Is Etoricoxib safe for kidneys?

The NSAIDs are extensively studied across various populations for their effects on renal function. The studies have shown COX-2 inhibitors are relatively safer than COX-1 inhibitors. Etoricoxib being a COX-2 inhibitor, is relatively safe for kidneys. A comparative study between naproxen, Ibuprofen (both selective COX-2 inhibitors), and Etoricoxib demonstrated that less than 2% of the 4700 study participants presented symptoms of kidney disorders.

7. Is Etoricoxib stronger than Ibuprofen?

Various European clinical studies have shown that Etoricoxib is as effective as Ibuprofen in providing relief from pain and inflammation. The side effects seen across the users were also similar across various clinical settings. Etoricoxib is generally preferred over Ibuprofen for long-term consumption due to its lesser tendency to cause stomach irritation than common painkillers like Ibuprofen. Usually, Ibuprofen is a choice of drug for injuries like bruises wherein pain is acute but requires medication for a few days to a week. Etoricoxib is a choice of drug for chronic pain like osteoarthritis wherein the prescription must be taken for weeks to months.

8. How long does it take for Etoricoxib to work?

The peak plasma concentration of Etoricoxib is seen within one hour of taking the tablet or after injection. It takes Etoricoxib at least one hour to bring in pain and swelling relief. Its half-life is 20-hours, and it is eliminated through urine. Thus, only one dose per day is recommended.

9. When is the best time to take Etoricoxib?

Since Etoricoxib is a food-neutral drug, you can take it before or after food. Studies have shown that Etoricoxib, when taken on an empty stomach has a faster pain-relieving effect. The pain-relieving effect of Etoricoxib lasts for at least a day with a single tablet. Post-marketing studies have recommended consuming the tablet during breakfast, usually supplemented with an antacid for best pain and swelling relief with minimum side effects. However, your physician might suggest a different time based on your medical condition.

 

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