[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Nonsteroidal anti-inflammatory drugs (NSAIDs)](https://durgical.com/en/pharmacology/classes/nonsteroidal-anti-inflammatory-drugs/) › Etoricoxib

# 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.

Updated Nov 1, 2026

## Quick facts

**Group**
[Nonsteroidal anti-inflammatory drugs (NSAIDs)](https://durgical.com/en/pharmacology/classes/nonsteroidal-anti-inflammatory-drugs/)

**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.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Clinical What the labels mean

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

✂**Cyclooxygenase 2 (COX-2)**Etoricoxib

ⓘ The figure shows celecoxib, another coxib, in the active site of mouse COX-2; etoricoxib binds the same COX-2 pocket.

**Target in 3D:** Cyclooxygenase 2 (COX-2). PDB structure 3LN1 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/3LN1) · Drag to rotate · pinch to zoom

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 →](https://durgical.com/en/conditions/knee-osteoarthritis/)
- Rheumatoid arthritis [Rheumatoid arthritis →](https://durgical.com/en/conditions/rheumatoid-arthritis/)
- Ankylosing spondylitis [Ankylosing spondylitis →](https://durgical.com/en/conditions/ankylosing-spondylitis/)
- Acute gouty arthritis [Gout →](https://durgical.com/en/conditions/gout/)
- Short-term postoperative pain and primary dysmenorrhoea [Dysmenorrhoea →](https://durgical.com/en/conditions/dysmenorrhoea/)

## Adverse effects

### Common

- Raised blood pressure and swelling
- Indigestion and abdominal pain (class effects of NSAIDs)

### Serious (rare, important)

- Heart attack and stroke, with more cardiorenal events than other coxibs
- Bleeding, ulcer or perforation of the stomach or bowel, sometimes without warning
- Kidney injury and high potassium; worse heart failure and blood pressure
- Severe skin reactions and DRESS

## 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

## Memory aid

Etoricoxib: «E for Elevated pressure» – the most selective coxib in this group; check BP first.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/etoricoxib/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## What the labels mean

**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…

## Connections

## Related drugs 4

- [Celecoxib](https://durgical.com/en/pharmacology/celecoxib/)
- [Diclofenac](https://durgical.com/en/pharmacology/diclofenac/)
- [Naproxen](https://durgical.com/en/pharmacology/naproxen/)
- [Ibuprofen](https://durgical.com/en/pharmacology/ibuprofen/)

## Related conditions 5

- [Knee Osteoarthritis](https://durgical.com/en/conditions/knee-osteoarthritis/)
- [Rheumatoid arthritis](https://durgical.com/en/conditions/rheumatoid-arthritis/)
- [Ankylosing spondylitis](https://durgical.com/en/conditions/ankylosing-spondylitis/)
- [Gout](https://durgical.com/en/conditions/gout/)
- [Dysmenorrhoea](https://durgical.com/en/conditions/dysmenorrhoea/)

[← Back to the class: Nonsteroidal anti-inflammatory drugs (NSAIDs)](https://durgical.com/en/pharmacology/classes/nonsteroidal-anti-inflammatory-drugs/)

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](https://www.ema.europa.eu/en/news/emea-recommends-strengthening-warnings-contraindications-etoricoxib-containing-medicines-used-treatment-rheumatoid-arthritis-ankylosing-spondylitis) (European Medicines Agency, 2008); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=M01AH05) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/etoricoxib/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/etoricoxib/