Arcoxia (etoricoxib) represents a significant advancement in the management of chronic inflammatory pain conditions. As a selective COX-2 inhibitor, this prescription medication offers a sophisticated mechanism of action that specifically targets inflammation and pain while demonstrating a potentially improved gastrointestinal safety profile compared to traditional nonsteroidal anti-inflammatory drugs (NSAIDs). Developed through extensive clinical research, Arcoxia provides healthcare professionals with a valuable therapeutic option for patients requiring long-term anti-inflammatory and analgesic management. This comprehensive product card details the pharmacological characteristics, clinical applications, and safety considerations essential for appropriate prescribing decisions.

Features

• Active ingredient: Etoricoxib (30mg, 60mg, 90mg, 120mg tablets)
• Pharmacological class: Selective cyclooxygenase-2 (COX-2) inhibitor
• Prescription-only medication requiring medical supervision
• Once-daily dosing regimen for consistent therapeutic coverage
• Rapid onset of action with peak plasma concentrations within approximately 1 hour
• Extended half-life of approximately 22 hours maintaining therapeutic levels
• High protein binding (approximately 92%) ensuring stable pharmacokinetics
• Hepatic metabolism primarily via CYP450 enzymes with fecal elimination

Benefits

• Provides potent anti-inflammatory and analgesic effects specifically targeting prostaglandin-mediated pain pathways
• Demonstrates reduced risk of gastrointestinal complications compared to non-selective NSAIDs
• Offers convenient once-daily dosing that enhances patient compliance and consistent symptom control
• Maintains effective 24-hour pain relief for chronic inflammatory conditions
• Shows no significant antiplatelet effects, making it suitable for patients requiring pain management without interference with coagulation
• Provides targeted therapy that spares COX-1 enzymes, preserving protective prostaglandin functions

Common use

Arcoxia is clinically indicated for the symptomatic treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and acute gouty arthritis. It is also approved for the management of chronic musculoskeletal pain and primary dysmenorrhea. The medication works by selectively inhibiting cyclooxygenase-2 (COX-2), the enzyme responsible for producing prostaglandins that mediate pain, inflammation, and fever. Unlike traditional NSAIDs that inhibit both COX-1 and COX-2 enzymes, Arcoxia’s selective action specifically targets inflammatory pathways while largely sparing COX-1, which maintains protective functions in the gastrointestinal tract, kidneys, and platelets. This targeted approach makes it particularly valuable for patients who require long-term anti-inflammatory therapy but may be at risk for gastrointestinal complications associated with non-selective NSAID use.

Dosage and direction

The recommended dosage of Arcoxia should be individualized based on the specific condition being treated and patient factors. For osteoarthritis: 30mg once daily. For rheumatoid arthritis: 60mg once daily, which may be increased to 90mg once daily in patients who don’t respond to 60mg. For ankylosing spondylitis: 90mg once daily. For acute gouty arthritis: 120mg once daily for maximum 8 days. The lowest effective dose should be used for the shortest duration possible. Tablets should be swallowed whole with water, with or without food, although taking with food may improve gastrointestinal tolerance. Dosage adjustment is necessary for patients with hepatic impairment, and the medication is not recommended for patients with severe hepatic dysfunction. Elderly patients may require dose adjustments based on renal function assessment.

Precautions

Arcoxia should be used with caution in patients with a history of cardiovascular disease or risk factors for cardiovascular events, as COX-2 inhibitors have been associated with increased risk of thrombotic events. Regular monitoring of blood pressure is recommended during treatment. Patients with pre-existing renal impairment require careful assessment and monitoring, as prostaglandins play a role in maintaining renal blood flow. Hepatic function should be monitored periodically during long-term therapy. Use with caution in patients with dehydration or hypovolemia, as these conditions may increase the risk of renal complications. Patients with a history of asthma, especially aspirin-sensitive asthma, should be monitored closely as cross-reactivity, though rare, may occur. Long-term therapy requires periodic evaluation of the continued need for treatment and assessment of gastrointestinal, cardiovascular, and renal safety parameters.

Contraindications

Arcoxia is contraindicated in patients with known hypersensitivity to etoricoxib or any components of the formulation. It must not be used in patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. Contraindications include established ischemic heart disease, peripheral arterial disease, cerebrovascular disease, and congestive heart failure (NYHA Class II-IV). Patients with active peptic ulceration or gastrointestinal bleeding should not receive Arcoxia. The medication is contraindicated in patients with severe hepatic dysfunction (Child-Pugh score ≥9), moderate to severe renal impairment (creatinine clearance <30 mL/min), and during the third trimester of pregnancy. Concomitant use with other NSAIDs, including COX-2 selective inhibitors, is contraindicated due to increased risk of adverse effects.

Possible side effect

The most commonly reported adverse reactions include dizziness (4.5%), headache (4.8%), and peripheral edema (4.6%). Gastrointestinal effects may include dyspepsia (5.5%), nausea (3.6%), abdominal pain (2.8%), and heartburn (2.3%). Less frequent but potentially serious adverse effects include hypertension (8.1%), exacerbation of pre-existing hypertension, and fluid retention. Cardiovascular events such as myocardial infarction and stroke have been reported with COX-2 inhibitors. Gastrointestinal serious adverse events including ulceration, bleeding, and perforation may occur, though at a lower incidence than with non-selective NSAIDs. Hepatic enzyme elevations (ALT/AST) occur in approximately 4% of patients, with rare cases of hepatitis reported. Hypersensitivity reactions including rash, urticaria, and angioedema may occur in susceptible individuals.

Drug interaction

Arcoxia demonstrates several clinically significant drug interactions that require careful management. Concomitant use with warfarin may increase INR and risk of bleeding, requiring close monitoring. Lithium levels may increase due to reduced renal clearance, necessitating lithium level monitoring. ACE inhibitors and angiotensin II antagonists may have their antihypertensive effects diminished. Diuretics may have reduced efficacy due to prostaglandin inhibition. Methotrexate levels may increase when co-administered with Arcoxia. Rifampicin, a potent CYP450 inducer, decreases etoricoxib concentrations by approximately 65%. Cyclosporine and tacrolimus may have increased nephrotoxic potential when combined with Arcoxia. Concomitant use with other NSAIDs or aspirin increases gastrointestinal risk without therapeutic benefit.

Missed dose

If a dose of Arcoxia is missed, patients should take it as soon as they remember, unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed dose, as this may increase the risk of adverse effects. The extended half-life of etoricoxib (approximately 22 hours) means that occasional missed doses are unlikely to significantly affect therapeutic efficacy, though consistency in dosing helps maintain stable plasma concentrations. Patients should be advised to maintain a regular dosing schedule and consider using reminder systems if missed doses occur frequently.

Overdose

In cases of overdose, supportive care is the mainstay of treatment as there is no specific antidote for etoricoxib. Symptoms may include lethargy, drowsiness, nausea, vomiting, epigastric pain, gastrointestinal bleeding, hypertension, acute renal failure, and respiratory depression. Management should include gastric lavage or activated charcoal if presentation is within one hour of ingestion. Supportive measures include maintaining adequate hydration, monitoring renal function, and managing gastrointestinal symptoms. Hemodialysis is not likely to be effective due to high protein binding. Patients should be monitored for at least 24 hours due to the drug’s long half-life. Symptomatic treatment for hypertension, gastrointestinal effects, or renal impairment should be instituted as necessary. Medical toxicology consultation is recommended in significant overdose situations.

Storage

Arcoxia tablets should be stored at room temperature between 15°C and 30°C (59°F to 86°F) in their original container to protect from moisture and light. The medication should be kept in a secure location out of reach of children and pets. Tablets should not be stored in bathrooms or other areas with high humidity. Do not use Arcoxia beyond the expiration date printed on the packaging. Proper disposal of unused medication is important to prevent accidental ingestion or environmental contamination. Patients should be advised not to flush medications down the toilet but instead utilize medication take-back programs or follow specific disposal instructions provided by their pharmacist.

Disclaimer

This product information is intended for healthcare professionals and provides summary information about Arcoxia. It does not include all available information about the medication and does not take the place of talking to a healthcare provider about medical conditions or treatment. Patients should be advised to read the medication guide provided with their prescription and discuss any questions with their physician or pharmacist. The prescribing physician should consider the official prescribing information for complete details regarding indications, dosing, warnings, and precautions. Treatment decisions should be based on the individual patient’s medical history, current condition, and risk factors. This information is subject to change as new clinical data becomes available.

Reviews

Clinical studies involving over 13,000 patients have demonstrated Arcoxia’s efficacy in managing chronic inflammatory conditions. In a 12-week study of osteoarthritis patients, Arcoxia 30mg and 60mg demonstrated significant improvement in pain and physical function compared to placebo, with efficacy comparable to diclofenac 150mg. Rheumatoid arthritis studies showed Arcoxia 90mg provided similar efficacy to naproxen 1000mg in reducing joint pain and morning stiffness. The MEDAL program, a large-scale outcomes study, compared etoricoxib with diclofenac and found similar cardiovascular risk profiles with significantly lower rates of gastrointestinal complications. Gastroenterologists have noted the reduced endoscopic ulcer incidence compared to non-selective NSAIDs. Rheumatologists report good patient satisfaction with the once-daily dosing and sustained pain relief. Some cardiologists express caution regarding long-term use in patients with cardiovascular risk factors, emphasizing the need for individual risk assessment and periodic reevaluation of therapy.