Etoricoxib
In brief
- Etoricoxib is a prescription-only medicine (POM) in the UK.
- Etoricoxib is used to treat pain and inflammation in osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, chronic low back pain, acute gout and acute dental pain; it is a highly selective COX‑2 inhibitor that reduces prostaglandin synthesis.
- The usual dose is 30–120 mg once daily depending on indication — osteoarthritis 30–60 mg, rheumatoid arthritis 90 mg, ankylosing spondylitis 90 mg, acute gout 120 mg (maximum 8 days), acute dental pain 90 mg (up to 3 days).
- Form of administration: oral tablets (30 mg, 60 mg, 90 mg and 120 mg); no injectable or topical formulations are registered in the UK.
- Onset time: analgesic effect usually begins within about 30–60 minutes after an oral dose.
- Duration of action: approximately 24 hours, allowing once‑daily dosing.
- Alcohol warning: avoid or limit alcohol as it can increase the risk of gastrointestinal bleeding, liver injury and may worsen dizziness or hypertension when taking etoricoxib.
- The most common side effect is headache.
- Would you like to try etoricoxib without a prescription?
Legal status and availability in the UK
Etoricoxib is a prescription-only medicine (POM) in the UK.
In our online pharmacy, etoricoxib is available without a prescription, with discreet delivery to the United Kingdom in 9–21 days.
Basic etoricoxib information
- INN (international nonproprietary name): Etoricoxib.
- Brand names available in the United Kingdom: Arcoxia; generic etoricoxib (e.g. Etoricoxib Accord)
- ATC code: M01AH05
- Forms and dosages: Oral tablets 30 mg, 60 mg, 90 mg and 120 mg
- Manufacturers in the United Kingdom: Merck Sharp & Dohme (MSD), Accord, Milpharm
- Registration status in the United Kingdom: Licensed by the MHRA
- OTC / Rx classification: Prescription-only medicine (POM)
Product overview, formulations and packaging
Available strengths and brand options
Etoricoxib tablets are supplied as 30 mg, 60 mg, 90 mg and 120 mg oral tablets.
Branded Arcoxia from MSD and generics from Accord and others supply the UK market.
Typical pack formats are blisters of 28 or 30 tablets.
| Brand | Strength | Pack size | Typical form |
|---|---|---|---|
| Arcoxia (MSD) | 60 mg, 90 mg, 120 mg | Blister x28 | Film-coated tablet |
| Etoricoxib Accord | 60 mg, 90 mg, 120 mg | Blister x28 | Film-coated tablet |
| Generic etoricoxib | 60 mg, 90 mg, 120 mg | Blister x30 | Film-coated tablet |
Indications and typical dosing regimens
Condition-specific doses and duration
Which dose for which condition?
- Osteoarthritis → 30–60 mg once daily → long-term with periodic review.
- Rheumatoid arthritis → 90 mg once daily → extended use as clinically required.
- Ankylosing spondylitis → 90 mg once daily → extended or as needed.
- Acute gout → 120 mg once daily → up to 8 days maximum.
- Acute dental pain → 90 mg once daily → up to 3 days only.
Etoricoxib is a Prescription Only Medicine and clinicians should review long-term need, efficacy and safety at regular intervals.
Mechanism of action and clinical implications
COX‑2 selectivity and expected benefits
How does etoricoxib relieve pain and what are the trade-offs?
Etoricoxib selectively inhibits the cyclo‑oxygenase‑2 enzyme, reducing prostaglandin production that drives pain and inflammation.
Greater COX‑2 selectivity compared with non‑selective NSAIDs tends to reduce upper gastrointestinal irritation linked to COX‑1 inhibition.
The clinical advantage is effective once‑daily analgesia with a potentially lower risk of stomach ulceration compared with some non‑selective NSAIDs.
Selective COX‑2 inhibition, however, can be associated with pro‑thrombotic cardiovascular risk in susceptible patients, so benefits must be balanced against cardiovascular history.
- Pros: Once-daily dosing, targeted anti-inflammatory effect, lower upper GI irritation than some non-selective NSAIDs.
- Cons: Increased cardiovascular risk in high-risk patients, potential for fluid retention and elevated blood pressure.
Contraindications and patient selection
Absolute and relative contraindications
Who must not take etoricoxib and who needs close monitoring?
- Absolute contraindications: Hypersensitivity to etoricoxib or other coxibs.
- Absolute contraindications: Active peptic ulcer or gastrointestinal bleeding.
- Absolute contraindications: Severe hepatic impairment.
- Absolute contraindications: Severe renal impairment (eGFR <30 mL/min).
- Absolute contraindications: Heart failure, uncontrolled hypertension, established ischaemic heart disease, peripheral arterial disease or cerebrovascular disease.
- Relative cautions: Known cardiovascular risk factors, elderly patients, diabetes, moderate hepatic or renal impairment.
Side effects, monitoring and what patients should be told
Common adverse effects and red flags
What should patients expect and what needs monitoring?
| Common side effects | Serious events | Monitoring frequency |
|---|---|---|
| Headache, dizziness, peripheral oedema, hypertension, dyspepsia, nausea, transient LFT rises. | GI bleeding / ulceration, cardiovascular events (MI, stroke), severe hepatic injury. | Baseline blood pressure and renal function; LFTs and renal tests periodically for long‑term use (e.g., every 3–6 months depending on risk). |
Tell patients to report chest pain, sudden shortness of breath, marked leg swelling, severe abdominal pain or black stools straight away.
Advise that mild symptoms such as headache or nausea are common but should be reviewed if persistent.
Drug interactions and co‑prescribing rules
High‑risk combinations and pharmacist actions
Which drug combinations require action at the pharmacy?
| Concomitant drug | Interaction | Pharmacist action |
|---|---|---|
| ACE inhibitors / ARBs / diuretics | Risk of reduced renal function and diminished antihypertensive effect. | Check renal function, advise monitoring and liaise with prescriber if AKI risk. |
| Anticoagulants / SSRIs | Increased risk of bleeding. | Advise bleeding precautions, confirm indication and monitor INR where relevant. |
| Aspirin / Other NSAIDs | Additive GI and cardiovascular risk; reduced safety. | Avoid combination unless specifically advised; seek prescriber clarification. |
| Lithium / Methotrexate | Reduced clearance and risk of toxicity. | Recommend monitoring serum levels and renal function; notify prescriber. |
Renal, hepatic and elderly dosing considerations
Adjustment guidance and contraindications
How should dosing change for organ impairment and older patients?
- Renal: Avoid in severe renal impairment (eGFR <30 mL/min).
- Hepatic: Mild impairment → limit to 60 mg/day.
- Hepatic: Moderate impairment → 60 mg every other day.
- Hepatic: Severe impairment → contraindicated.
- Elderly: No automatic dose reduction for age alone but monitor renal function, blood pressure and concomitant medicines closely.
- Paediatrics: Not indicated for children.
When in doubt, consult the SPC for detailed dose-adjustment rules and liaise with the prescriber for frail or multi‑morbid patients.
Overdose, missed doses and storage/disposal
Patient instructions
What to do in the event of a missed dose or accidental overdose?
- Missed dose: Take as soon as remembered unless the next dose is due; do not double up to make up the dose.
- Overdose: Seek emergency care immediately; there is no specific antidote and management is supportive with monitoring of renal, hepatic and cardiovascular status.
- Storage: Store below 30°C, away from moisture and light; do not refrigerate and keep in original packaging during transport.
- Disposal: Return unused tablets to a pharmacy medicine take‑back service for safe disposal.
Alternatives
When to choose etoricoxib vs others
Which patients are best suited to etoricoxib and what alternatives exist?
| Comparator | Pros | Cons | Typical dose |
|---|---|---|---|
| Celecoxib | COX‑2 selectivity, once or twice daily options | Similar CV caution in high‑risk patients | 100–200 mg once or twice daily |
| Naproxen / Ibuprofen | Widely available, lower CV signal for naproxen | More upper GI irritation; multiple daily dosing | Naproxen 250–500 mg twice daily; Ibuprofen 200–400 mg up to TDS |
| Topical NSAIDs | Lower systemic exposure, good for local OA | Less suitable for systemic inflammatory disease | Apply per product instructions |
Etoricoxib is suitable where once‑daily COX‑2 therapy is preferred and gastrointestinal risk reduction is important, provided cardiovascular risk is low.
Consider gastroprotection with a PPI where GI risk remains a concern and review any low‑dose aspirin use due to antiplatelet interactions.
Delivery across the United Kingdom
| City | Region | Delivery Time |
|---|---|---|
| London | England | 9–21 days |
| Birmingham | England | 9–21 days |
| Manchester | England | 9–21 days |
| Glasgow | Scotland | 9–21 days |
| Leeds | England | 9–21 days |
| Liverpool | England | 9–21 days |
| Bristol | England | 9–21 days |
| Edinburgh | Scotland | 9–21 days |
| Cardiff | Wales | 9–21 days |
| Belfast | Northern Ireland | 9–21 days |
| Newcastle | England | 9–21 days |
| Sheffield | England | 9–21 days |
| Nottingham | England | 9–21 days |
| Southampton | England | 9–21 days |
| Portsmouth | England | 9–21 days |
Practical pharmacy checklist and closing notes
What to do at dispensing
Use this short checklist when dispensing etoricoxib.
- Verify prescription and indication against typical dosing regimens.
- Check cardiovascular history, blood pressure and renal function records.
- Screen for interacting medicines such as anticoagulants, lithium or methotrexate.
- Provide the PIL and advise on red‑flag symptoms and storage/disposal.
- Record batch and expiry and keep a counselling note for repeat supply.
Patients should be encouraged to contact the pharmacist or prescriber if they experience worrying side effects or if they are starting new medicines that might interact.
