Etoricoxib

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.