COX-2 Selective NSAID Pregnancy: Contraindicated in pregnancy especially third trimester — premature ductus arteriosus closure

Etoricoxib

Brand names: Arcoxia

Adult dose

Dose: OA: 30–60 mg; RA/AS: 60–90 mg; Acute gout: 120 mg (max 8 days)

Route: Oral

Frequency: Once daily

Max: 120 mg/day (acute gout only, max 8 days)

Contraindicated if eGFR <30; avoid in uncontrolled hypertension (BP >140/90); MHRA 2019: lowest effective dose shortest duration; gastroprotection with PPI for high-risk patients

Paediatric dose

Route: N/A

Frequency: N/A

Max: Not licensed under 16 years

Not recommended in children

Dose adjustments

Renal

Avoid if eGFR <30 mL/min

Hepatic

Max 60 mg/day in moderate impairment; avoid in severe

Clinical pearls

Acute gout: 120 mg once daily limited to 8 days maximum — as effective as indomethacin with fewer GI side effects; MHRA-approved dose specifically for acute gout; reduce to maintenance dose once acute attack resolves
Ankylosing spondylitis: 60–90 mg once daily — evidence suggests continuous use may slow radiographic progression unlike non-selective NSAIDs; unique property among COX-2 inhibitors
MHRA 2019 review: all COX-2 inhibitors increase risk of MI, stroke, and heart failure — cardiovascular risk assessment mandatory before prescribing; etoricoxib is most selective COX-2 inhibitor available in the UK
Blood pressure check mandatory before prescribing: contraindicated if systolic >140 mmHg; monitor BP after starting — reduces diuretic and antihypertensive efficacy
GI advantage over non-selective NSAIDs: significantly fewer GI ulcers (EDGE trial) — preferred when GI protection is priority; still use PPI if high GI risk (age >65, prior ulcer, anticoagulant use)

Contraindications

Active peptic ulcer
Uncontrolled hypertension
Ischaemic heart disease
Peripheral arterial disease
Cerebrovascular disease
eGFR <30
Sulfonamide allergy
NSAID hypersensitivity

Side effects

Hypertension (dose-dependent)
Oedema
GI upset
Headache
Elevated liver enzymes
Fluid retention

Interactions

ACE inhibitors/ARBs — reduced antihypertensive effect and AKI risk
Diuretics — reduced efficacy
Warfarin — INR monitoring required
Lithium — increased levels
Ciclosporin/tacrolimus — nephrotoxicity

Monitoring

BP before and after starting
Renal function (U&E)
LFTs if prolonged use
Oedema
Cardiovascular symptoms

Reference: BNFc; BNF 90; MHRA Drug Safety Update 2019 (COX-2 inhibitors); NICE NG79 (OA); EDGE II trial; SPC Arcoxia; NICE TA383. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Pathways