COX-2 Selective NSAID Pregnancy: Contraindicated in pregnancy — no clinical data on exposed pregnancies, animal studies have shown reproductive toxicity, and like other prostaglandin synthesis inhibitors it may cause uterine inertia and premature closure of the ductus arteriosus in the last trimester; if a woman becomes pregnant during treatment, etoricoxib must be discontinued. Contraindicated in breast-feeding — women who use etoricoxib must not breast feed. Not recommended in women attempting to conceive.

Etoricoxib

Brand names: Arcoxia

Etoricoxib is a selective COX-2 inhibitor (coxib) NSAID used for pain and inflammation in osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, gout and acute musculoskeletal pain.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Osteoarthritis: 30 mg once daily; in some patients with insufficient relief of symptoms an increased dose of 60 mg once daily may increase efficacy

Route: Oral — may be taken with or without food; onset of effect may be faster when taken without food

Frequency: Once daily

Max: Indication-specific maxima: osteoarthritis must not exceed 60 mg daily; rheumatoid arthritis and ankylosing spondylitis must not exceed 90 mg daily; acute gout must not exceed 120 mg daily and is limited to a maximum of 8 days of treatment; postoperative acute dental surgery pain must not exceed 90 mg daily and is limited to a maximum of 3 days

Because the cardiovascular risks of etoricoxib may increase with dose and duration of exposure, the shortest possible duration and the lowest effective daily dose should be used, and the need for symptomatic relief and response to therapy re-evaluated periodically (especially in osteoarthritis). OTHER INDICATIONS in §4.2: rheumatoid arthritis 60 mg once daily, increased to 90 mg once daily in some patients with insufficient relief, with down-titration to 60 mg once clinically stabilised; ankylosing spondylitis 60 mg once daily, increased to 90 mg once daily in some patients, with down-titration to 60 mg once stabilised; acute gouty arthritis 120 mg once daily (given for 8 days in clinical trials); postoperative dental surgery pain 90 mg once daily limited to a maximum of 3 days, with some patients requiring additional postoperative analgesia. Doses greater than those recommended for each indication have either not demonstrated additional efficacy or have not been studied. HEPATIC IMPAIRMENT (regardless of indication): mild (Child-Pugh 5–6) do not exceed 60 mg once daily; moderate (Child-Pugh 7–9) do not exceed 30 mg once daily, with caution as clinical experience is limited; severe (Child-Pugh 10 or above) is contraindicated. Elderly: no dosage adjustment necessary, but caution should be exercised. PAEDIATRIC: contraindicated in children and adolescents under 16 years of age. PROVENANCE: fetched eMC product is Arcoxia 60 mg film-coated tablets. §4.5 (interactions) was not part of the fetched bundle; §4.4 and §4.8 were truncated at the source-fetch limit.

Dose adjustments

Renal

No dosage adjustment is necessary for patients with creatinine clearance of 30 mL/min or above. Use in patients with creatinine clearance below 30 mL/min is contraindicated.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Active peptic ulceration or active gastro-intestinal bleeding
Patients who, after taking acetylsalicylic acid or NSAIDs including COX-2 inhibitors, experience bronchospasm, acute rhinitis, nasal polyps, angioneurotic oedema, urticaria or allergic-type reactions
Pregnancy and lactation
Severe hepatic dysfunction (serum albumin below 25 g/L or Child-Pugh score 10 or above); estimated renal creatinine clearance below 30 mL/min
Children and adolescents under 16 years of age; inflammatory bowel disease
Congestive heart failure (NYHA II-IV); hypertension persistently above 140/90 mmHg and not adequately controlled; established ischaemic heart disease, peripheral arterial disease and/or cerebrovascular disease

Side effects

Oedema/fluid retention and hypertension (common)
Dizziness and headache (common)
Palpitations and arrhythmia (common); atrial fibrillation, tachycardia, congestive heart failure, angina pectoris and myocardial infarction (uncommon)
Upper gastrointestinal complications — perforations, ulcers and bleeding, some fatal; alveolar osteitis (common); gastroenteritis (uncommon)
Anaemia primarily associated with gastrointestinal bleeding, leukopenia and thrombocytopenia (uncommon)
Hypersensitivity (uncommon); angioedema/anaphylactic/anaphylactoid reactions including shock (rare); cerebrovascular accident and transient ischaemic attack

Interactions

Acetylsalicylic acid, even at low doses — further increase in the risk of gastrointestinal ulceration and other gastrointestinal complications when taken concomitantly with etoricoxib (§4.4)
Other NSAIDs — concomitant use increases the risk of gastrointestinal complications (§4.4)
Antiplatelet therapy must not be discontinued: COX-2 selective inhibitors are not a substitute for acetylsalicylic acid for prophylaxis of cardiovascular thrombo-embolic disease because they lack antiplatelet effect (§4.4)
Full §4.5 interaction section was not retrieved in this bundle — check the SPC directly before relying on this list

Clinical monograph

How it works

It selectively inhibits cyclo-oxygenase-2, suppressing inflammatory prostaglandin synthesis while largely sparing COX-1-mediated gastric mucosal protection.

Prescribing in practice

Contraindicated in uncontrolled hypertension and established ischaemic heart disease, cerebrovascular or peripheral arterial disease because of dose-dependent cardiovascular and blood-pressure risk.
Blood pressure should be controlled before starting and reviewed shortly after initiation, as etoricoxib has a notable hypertensive effect.
Avoid in active peptic ulceration, severe hepatic impairment, severe renal impairment and the later stages of pregnancy.

Monitoring

Monitor blood pressure (particularly in the first weeks) and renal function, especially in older or cardiovascular-risk patients.

Counselling the patient

Your blood pressure needs checking after you start this medicine.
Report swelling of the ankles, breathlessness or chest pain.
Lower gastric risk than older NSAIDs does not remove cardiovascular risk.

Evidence & guidelines

MHRA advises COX-2 inhibitors are contraindicated in established cardiovascular disease and should be used at the lowest effective dose for the shortest time.

Reference: MHRA Drug Safety Update 2019 (COX-2 inhibitors); NICE NG79 (OA); EDGE II trial; SPC Arcoxia; NICE TA383; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Pathways