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Selective COX-2 Inhibitor Pregnancy: C (D in third trimester)

Etoricoxib

Brand names: Arcoxia

Adult dose

Dose: 60 mg once daily (OA); 90 mg once daily (RA/AS); 120 mg once daily (acute gout — max 8 days)
Route: oral
Frequency: once daily
Max: 120 mg/day (short-term acute gout)
Lower GI risk than non-selective NSAIDs but increased cardiovascular risk; not licensed in US; NICE recommends only when other treatments failed

Paediatric dose

Route:
Not licensed in children

Dose adjustments

Renal

Avoid if eGFR <30 ml/min

Hepatic

Max 60 mg in mild-moderate hepatic impairment; avoid in severe

Clinical pearls

  • MEDAL programme: comparable cardiovascular risk to diclofenac but superior GI profile
  • Contraindicated in established cardiovascular disease — cardiovascular risk similar to non-selective NSAIDs
  • Acute gout: 120 mg effective — use for max 8 days only at this dose

Contraindications

  • Active peptic ulcer
  • Ischaemic heart disease
  • CVA/TIA
  • Peripheral arterial disease
  • Heart failure (NYHA II-IV)
  • Uncontrolled hypertension (>140/90)
  • eGFR <30 ml/min

Side effects

  • Hypertension (dose-dependent)
  • Peripheral oedema
  • GI upset
  • Headache
  • Dizziness
  • Elevated LFTs
  • Renal impairment

Interactions

  • Warfarin (INR increase)
  • Lithium (increased levels)
  • ACE inhibitors/ARBs (reduced effect)
  • Ciclosporin (increased nephrotoxicity)

Monitoring

  • Blood pressure
  • Renal function
  • LFTs
  • Cardiovascular risk assessment before prescribing

Reference: BNFc; BNF 86; NICE NG143; MEDAL programme. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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