Etoricoxib

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.