Selective COX-2 Inhibitor Pregnancy: Contraindicated in pregnancy; if a woman becomes pregnant during treatment etoricoxib must be discontinued. May cause uterine inertia and premature closure of the ductus arteriosus during the last trimester. Women who use etoricoxib must not breast-feed. Use is not recommended in women attempting to conceive.

Etoricoxib

Brand names: Arcoxia

Etoricoxib is a selective cyclo-oxygenase-2 (COX-2) inhibitor NSAID used for osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, gout and other painful inflammatory conditions.

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 an increased dose of 60 mg once daily may increase efficacy. Rheumatoid arthritis and ankylosing spondylitis: 60 mg once daily; in some patients with insufficient relief an increased dose of 90 mg once daily may increase efficacy, with down-titration to 60 mg once daily once the patient is clinically stabilised.

Route: Oral (may be taken with or without food)

Frequency: Once daily

Max: 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, limited to a maximum of 8 days treatment; postoperative acute dental surgery pain must not exceed 90 mg daily, limited to a maximum of 3 days.

As the cardiovascular risks of etoricoxib may increase with dose and duration of exposure, the shortest duration possible and the lowest effective daily dose should be used, and the need for symptomatic relief and response to therapy should be re-evaluated periodically (especially in osteoarthritis). Acute pain conditions: etoricoxib should be used only for the acute symptomatic period. 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; some patients may require additional postoperative analgesia. Doses greater than those recommended for each indication have either not demonstrated additional efficacy or have not been studied. Elderly: no dosage adjustment necessary, but caution should be exercised. Hepatic impairment: mild dysfunction (Child-Pugh 5-6) do not exceed 60 mg once daily; moderate dysfunction (Child-Pugh 7-9) do not exceed 30 mg once daily (limited clinical experience, caution advised); severe dysfunction (Child-Pugh 10 or above) is contraindicated. Onset of effect may be faster when administered without food, which should be considered when rapid symptomatic relief is needed. Paediatric: etoricoxib is contraindicated in children and adolescents under 16 years of age. SPC section 4.5 (interactions) was not retrieved in this bundle and no US label was available - verify interactions against the full SPC.

Dose adjustments

Renal

No dosage adjustment is necessary for patients with creatinine clearance 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 with blood pressure persistently elevated above 140/90 mmHg and not adequately controlled
Established ischaemic heart disease, peripheral arterial disease and/or cerebrovascular disease

Side effects

Dizziness and headache (common)
Oedema/fluid retention (common)
Hypertension (common)
Palpitations and arrhythmia (common)
Alveolar osteitis (common)
Anaemia primarily associated with gastrointestinal bleeding, leukopenia, thrombocytopenia (uncommon); atrial fibrillation, congestive heart failure, angina pectoris, myocardial infarction and cerebrovascular accident (uncommon)

Clinical monograph

How it works

It selectively inhibits COX-2, reducing prostaglandin-mediated inflammation and pain while having relatively less effect on COX-1-dependent gastric and platelet function.

Prescribing in practice

It is associated with dose-related hypertension and cardiovascular risk, so it is contraindicated in uncontrolled hypertension and established ischaemic heart disease, cerebrovascular or peripheral arterial disease.
Blood pressure should be controlled before starting and reviewed after initiation, using the lowest effective dose for the shortest duration.
Despite COX-2 selectivity, gastrointestinal and renal risks remain, and caution is needed with anticoagulants and in renal or hepatic impairment.

Monitoring

Monitor blood pressure, renal function and for gastrointestinal symptoms during treatment.

Counselling the patient

Have your blood pressure checked as this medicine can raise it.
Report swelling, breathlessness or signs of gastrointestinal bleeding.
Use the lowest dose that controls your symptoms and review the need to continue.

Evidence & guidelines

MHRA advice highlights the cardiovascular and blood-pressure risks of COX-2 inhibitors including etoricoxib, and NICE supports cautious use with gastroprotection considerations.

Reference: NICE NG143; MEDAL programme; 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.

Calculators

Pathways