Etoricoxib; Uses, Dosage, Side Effects, Interactions Etoricoxib is a synthetic, nonsteroidal anti-inflammatory drug (NSAID) with antipyretic, analgesic, and potential antineoplastic properties. Etoricoxibspecifically binds to and inhibits the enzyme cyclooxygenase-2 (COX-2), resulting in inhibition of the conversion of arachidonic acid into prostaglandins. Inhibition of COX-2 may induce apoptosis and inhibit tumor cell proliferation and angiogenesis. Etoricoxib is a new COX-2 selective inhibitor. Current therapeutic indications are treatment of rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, chronic low back pain, acute pain, and gout. Like any other COX-2 selective inhibitor, Etoricoxib selectively inhibits isoform 2 of cyclo-oxygenase enzyme (COX-2). This reduces the generation of prostaglandins (PGs) from arachidonic acid. Mechanism of Action of Etoricoxib Like any other selective COX-2 inhibitor (“coxib”), etoricoxib selectively inhibits isoform 2 of the enzyme cyclooxygenase (COX-2). It has approximately 106-fold selectivity for COX-2 inhibition over COX-1. This reduces the generation of prostaglandins (PGs) from arachidonic acid. Among the different functions exerted by PGs, their role in the inflammation cascade should be highlighted. Selective COX-2 inhibitors show less activity on COX-1 compared to traditional non-steroidal anti-inflammatory drugs (NSAID). This reduced activity is the cause of reduced gastrointestinal side effects, as demonstrated in several large clinical trials performed with different coxibs. Like any other COX-2 selective inhibitor Etoricoxib selectively inhibits isoform 2 of cyclo-oxygenase enzyme (COX-2). This reduces prostaglandins (PGs) generation from arachidonic acid. Indications of Etoricoxib Etoricoxib tablet is used for the treatment, control, prevention, & improvement of the following diseases, conditions, and symptoms: For the treatment of rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, chronic low back pain, acute pain, and gout. For the symptomatic relief of osteoarthritis (OA), rheumatoid arthritis (RA) and the pain and signs of inflammation associated with acute gouty arthritis Ankylosing spondylitis Pain due to especially musculoskeletal system Lumbago Low back pain PLID Poly arthralgia Muscles stiffness in nerve diseases Morning stiffness Multiple joint pain Steroid induce arthritis Muscles stiffness in spinal Muscles stiffness in muscle diseases Muscles stiffness in the joint diseases Pain caused by nonaticular rheutism Periarthritis of scapulohumerous Contra-Indications of Etoricoxib Allergy to etoricoxib or any other ingredients in the medicine; Allergy to medicines called opioid antagonists (e.g. codeine, morphine); Consumed alcohol taken another drug which affects your brain. These include: Some painkillers, including opioid pain killers; Hypnotic drugs; Psychotropic drugs; Used monoamine oxidase inhibitors (MAOIs) such as phenelzine or tranylcypromine Epilepsy; Addiction or are recovering from addiction to another medication. History of peptic ulcer disease, Gastrointestinal bleeding, Alcohol intolerance, Renal impairment, Cerebrovascular bleeding, Nasal polyps, Angioedema, and asthma Acute intoxication with alcohol, Hypnotics, Heart failure, Coagulation disorders, Renal impairment, Acute rhinitis Asthma Pregnant Hepatic impairment. Active peptic ulcer Dosage of Etoricoxib Strengths: 60 mg, 90 mg, 120 mg Ankylosing spondylitis, Rheumatoid arthritis 90 mg once daily. <16 yr Contraindicated. Osteoarthritis 30 mg once daily, increased to 60 mg once daily if needed. <16 yr Contraindicated. Acute Gout 120 mg once daily. Max duration: 8 days. <16 yr Contraindicated. Dental Pain 120 mg once daily. Side Effects of Etoricoxib The most common GI disorders (e.g. dyspepsia, abdominal pain, nausea, vomiting, diarrhoea, flatulence, constipation,, ulcerative stomatitis, ), indigestion, Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain. Drowsiness and lightheadedness Nausea and vomiting joint pain Nausea and vomiting Severe stomach ache Severe diarrhea Vaginal thrush Skin rash Headache Chest pain Diarrhea or loose stools Difficulty with breathing Dizziness Heartburn Muscle pain More common Abdominal or stomach pain, Chills or fever Headache, Joint or back pain Muscle aching or cramping Muscle pains or stiffness Chest pressure or squeezing pain in the chest Excessive sweating feeling of heaviness, pain, warmth and/or swelling in a leg or in the pelvis sudden tingling or coldness in an arm or leg Constipation Diarrhoea Loss of muscle coordination Sleepiness or unusual drowsiness Clumsiness or unsteadiness Drowsiness Rare Anxiety change in vision seizures abnormal or fast heart rate tremors weight loss chest pain or tightness confusion a cough Agitation arm, back, or jaw pain blurred vision chest pain or discomfort convulsions extra heartbeats hallucinations a headache irritability lightheadedness mood or mental changes muscle pain or cramps muscle spasm or jerking of all extremities muscle pains or stiffness chest pressure or squeezing pain in the chest discomfort in arms, shoulders, neck or upper back Drug Interactions of Etoricoxib Etoricoxib may interact with following drugs, supplyments & may change the efficacy of drugs aminoglycoside antibiotics (e.g., amikacin, gentamicin, tobramycin) angiotensin converting enzyme inhibitors (ACEIs; e.g., captopril, enalapril, ramipril) angiotensin receptor blockers (ARBs; e.g., candasartan, irbesartan, losartan) beta-adrenergic blockers (e.g., metoprolol, atenolol) calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil) celecoxib cilostazol clopidogrel corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone) cyclosporine diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene) 5-ASA medications (e.g, sulfasalazine) glucosamine haloperidol heparin methotrexate multivitamins other non-steroidal anti-inflammatory medications (NSAIDs;e.g., diclofenac, ibuprofen, ketorolac, naproxen) Omega-3 fatty acids pentoxifylline quinolone antibiotics (e.g., ciprofloxacin, ofloxacin) selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine,fluoxetine, paroxetine, sertraline) serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g, duloxetine, ) tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine) warfarin Pregnancy & Lactation of Etoricoxib FDA Pregnancy Category C Pregnancy You should not take etoricoxib tablets during the last 3 months of pregnancy as it may affect the baby s circulation. If you are in the first 6 months of pregnancy talk to your doctor before taking this medicine etoricoxib tablets should only be taken if the benefit is likely to outweigh the risks. Lactation Taking etoricoxib tablets may make it more difficult for you to get pregnant. You should talk to your doctor if you are planning to become pregnant or if you have problems getting pregnant. Before you take Note: Etoricoxib has not been approved by the FDA for the U.S. market. Do not take etoricoxib if: you have an allergy to etoricoxib or any of the ingredients listed at the end of this leaflet the packaging is torn or shows signs of tampering the expiry date on the pack has passed. If you take this medicine after the expiry date has passed, it may not work. You have had heart failure, a heart attack, bypass surgery, chest pain (angina), narrow or blocked arteries of the extremities (peripheral arterial disease), a stroke or mini stroke (TIA or transient ischaemic attack). You have high blood pressure that is not well controlled on blood pressure medication. You are having major surgery and have conditions which increase your risk of coronary artery disease or atherosclerosis such as high blood pressure, diabetes, high cholesterol or smoking. 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