Etoricoxib
NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs)Pregnancy: avoid
Avoid from week 20: from about 20 weeks NSAIDs can reduce amniotic fluid through their effect on the fetal kidney, and from about 30 weeks they can close the fetal ductus…
A long-acting COX-2-selective NSAID for arthritis and gout pain. It raises blood pressure and cardiovascular risk and is not marketed in the United States.
Quick facts
- Group
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Target
- Cyclooxygenase 2 (COX-2)
- Used for
- Osteoarthritis · Rheumatoid arthritis
- Key effects
- Raised blood pressure and swelling
- Monitor
- Blood pressure before starting · Kidney function
- ATC
- M01AH05
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows celecoxib, another coxib, in the active site of mouse COX-2; etoricoxib binds the same COX-2 pocket.
Etoricoxib is among the most COX-2-selective NSAIDs. Blocking COX-2 lowers the prostaglandins of inflammation and pain, while sparing COX-1 in the stomach and platelets more than older NSAIDs. Less prostacyclin with intact platelet thromboxane may explain the higher risk of heart attack and stroke.
- Blocks COX-2 selectively
- Fewer inflammatory prostaglandins: less pain and swelling
- COX-1 is spared, but prostacyclin falls and thrombotic risk rises
Indications
- Osteoarthritis Knee Osteoarthritis →
- Rheumatoid arthritis Rheumatoid arthritis →
- Ankylosing spondylitis Ankylosing spondylitis →
- Acute gouty arthritis Gout →
- Short-term postoperative pain and primary dysmenorrhoea Dysmenorrhoea →
Adverse effects
Common
- Raised blood pressure and swelling
- Indigestion and abdominal pain (class effects of NSAIDs)
Contraindications
- Hypertension that is not controlled
- Asthma, hives or allergic-type reactions after aspirin or another NSAID
- Pain around coronary artery bypass graft (CABG) surgery
Key interactions
- Warfarin, antiplatelets, SSRIs and SNRIs
- More bleeding, mainly in the gut
- ACE inhibitors, ARBs and diuretics
- Weaker blood-pressure and diuretic effect; risk of kidney injury
What is monitored
- Blood pressure before starting, in the first two weeks and regularly after
- Signs of gastrointestinal bleeding (black stools, vomiting blood, anaemia)
- Kidney function, potassium, liver tests and blood count in long-term use
Administration and safety
- Given by mouth once a day, at the lowest effective dose for the shortest time
- Blood pressure is controlled before the first dose
Pregnancy and breastfeeding
Avoid from week 20: from about 20 weeks NSAIDs can reduce amniotic fluid through their effect on the fetal kidney, and from about 30 weeks they can close the fetal ductus arteriosus too early.
Nursing care
- Measure blood pressure before treatment and at follow-up
- Ask about ulcers, bleeding, kidney or heart disease and aspirin-sensitive asthma before the first dose
- Teach to report black stools, vomiting blood, chest pain, weakness on one side or rash
- Teach to avoid taking another NSAID at the same time, including over-the-counter ones
Pharmacokinetics
- Absorption
- About 80% absorbed by mouth
- Metabolism
- Extensive metabolism before excretion; it accumulates in liver impairment
- Half-life
- Long, about 20 to 26 hours
Test yourself
Think of the answer, then tap the question to see it.
Which blood-pressure rule applies to etoricoxib?
It is contraindicated in uncontrolled hypertension, and blood pressure is checked before and after starting.
Why do COX-2-selective NSAIDs raise thrombotic risk?
They lower vascular prostacyclin while platelet thromboxane (COX-1) stays intact.
Is etoricoxib available in the United States?
No; it is approved in several other countries.
Connections
← Back to the class: Nonsteroidal anti-inflammatory drugs (NSAIDs)
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: EMEA recommends strengthening warnings and contraindications for etoricoxib-containing medicines used in the treatment of rheumatoid arthritis and ankylosing spondylitis (European Medicines Agency, 2008); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.