Coxitor
Generic Name
Etoricoxib
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Description
Overview of the medicine
Coxitor (Etoricoxib) is a non-steroidal anti-inflammatory drug (NSAID) specifically designed to inhibit cyclooxygenase-2 (COX-2). It is used to relieve pain and inflammation in various conditions.
Uses & Indications
Dosage
Adults
Osteoarthritis: 30 mg or 60 mg once daily. Rheumatoid Arthritis, Ankylosing Spondylitis: 60 mg or 90 mg once daily. Acute Gouty Arthritis: 120 mg once daily (maximum 8 days). Acute Pain/Dysmenorrhea: 60 mg or 120 mg once daily, not exceeding 8 days for acute pain. Dosage should be lowest effective for shortest duration.
Elderly
No dosage adjustment generally required, but caution is advised due to increased risk of adverse effects.
Renal_impairment
Mild to moderate (CrCl 30-80 mL/min): No dose adjustment. Severe (CrCl <30 mL/min): Not recommended.
How to Take
Coxitor tablets are for oral administration and can be taken with or without food. To minimize potential gastrointestinal discomfort, it may be taken with food or milk.
Mechanism of Action
Etoricoxib selectively inhibits the cyclooxygenase-2 (COX-2) enzyme, which is responsible for the synthesis of prostaglandins involved in inflammation, pain, and fever. By inhibiting COX-2, it reduces prostaglandin production, leading to anti-inflammatory, analgesic, and antipyretic effects.
Pharmacokinetics
Onset
Onset of analgesic action typically occurs within 24 minutes for acute pain.
Excretion
Approximately 70% is excreted in the urine and 20% in the feces, predominantly as metabolites.
Half life
Approximately 22 hours, allowing for once-daily dosing.
Absorption
Rapidly absorbed after oral administration, with peak plasma concentrations (Cmax) reached in approximately 1 hour.
Metabolism
Extensively metabolized via cytochrome P450 (CYP3A4) enzymes, primarily to inactive metabolites.
Side Effects
Contraindications
- Hypersensitivity to etoricoxib or any component of the formulation
- Active peptic ulceration or gastrointestinal bleeding
- Severe heart failure (NYHA Class II-IV)
- Established ischemic heart disease, peripheral arterial disease, and/or cerebrovascular disease
- Uncontrolled hypertension with blood pressure persistently above 140/90 mmHg
- Severe renal dysfunction (creatinine clearance <30 mL/min)
- Severe hepatic dysfunction
Drug Interactions
Lithium
Increased plasma lithium levels, leading to toxicity.
Warfarin
Increased risk of bleeding, monitor INR.
Diuretics
Reduced diuretic and antihypertensive effects.
Rifampicin
Decreased etoricoxib plasma concentrations.
Methotrexate
Increased plasma methotrexate levels, enhancing toxicity.
Oral Contraceptives
Increased plasma concentrations of oral contraceptive components (ethinyl estradiol).
ACE inhibitors/Angiotensin Receptor Blockers (ARBs)
Reduced antihypertensive effect, increased risk of renal impairment.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
In case of overdose, symptomatic and supportive measures should be initiated. There is no specific antidote. Dialysis is unlikely to be effective in removing etoricoxib.
Pregnancy & Lactation
Not recommended during pregnancy, especially in the third trimester, due to potential risks to the fetus (e.g., premature closure of the ductus arteriosus). Should be avoided during lactation as etoricoxib is excreted in breast milk.
Side Effects
Contraindications
- Hypersensitivity to etoricoxib or any component of the formulation
- Active peptic ulceration or gastrointestinal bleeding
- Severe heart failure (NYHA Class II-IV)
- Established ischemic heart disease, peripheral arterial disease, and/or cerebrovascular disease
- Uncontrolled hypertension with blood pressure persistently above 140/90 mmHg
- Severe renal dysfunction (creatinine clearance <30 mL/min)
- Severe hepatic dysfunction
Drug Interactions
Lithium
Increased plasma lithium levels, leading to toxicity.
Warfarin
Increased risk of bleeding, monitor INR.
Diuretics
Reduced diuretic and antihypertensive effects.
Rifampicin
Decreased etoricoxib plasma concentrations.
Methotrexate
Increased plasma methotrexate levels, enhancing toxicity.
Oral Contraceptives
Increased plasma concentrations of oral contraceptive components (ethinyl estradiol).
ACE inhibitors/Angiotensin Receptor Blockers (ARBs)
Reduced antihypertensive effect, increased risk of renal impairment.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
In case of overdose, symptomatic and supportive measures should be initiated. There is no specific antidote. Dialysis is unlikely to be effective in removing etoricoxib.
Pregnancy & Lactation
Not recommended during pregnancy, especially in the third trimester, due to potential risks to the fetus (e.g., premature closure of the ductus arteriosus). Should be avoided during lactation as etoricoxib is excreted in breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from the date of manufacture, specific expiry date is printed on the packaging.
Availability
Pharmacies, hospitals
Approval Status
Approved (in most countries where available)
Patent Status
Generic available
Clinical Trials
Etoricoxib has undergone extensive clinical trials demonstrating its efficacy and safety in various pain and inflammatory conditions, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and acute gouty arthritis. Trials have also assessed its cardiovascular and gastrointestinal safety profile compared to other NSAIDs.
Lab Monitoring
- Blood pressure monitoring (especially at initiation and during treatment)
- Renal function tests (e.g., serum creatinine, eGFR) periodically, especially in patients with pre-existing renal impairment or those on diuretics
- Hepatic function tests (e.g., ALT, AST) in patients with symptoms suggesting liver dysfunction or for long-term use
- Complete blood count (CBC) for signs of anemia or other hematologic abnormalities with long-term therapy
Doctor Notes
- Prescribe the lowest effective dose for the shortest possible duration consistent with individual patient treatment goals.
- Carefully assess patient's cardiovascular risk factors before prescribing and periodically during treatment.
- Monitor for signs and symptoms of gastrointestinal toxicity, including bleeding, ulceration, and perforation.
- Monitor blood pressure regularly, especially in patients with pre-existing hypertension or those at risk.
Patient Guidelines
- Take exactly as prescribed by your doctor.
- Do not exceed the recommended dose or duration of treatment.
- Report any unusual side effects, especially stomach pain, black stools, or swelling in ankles/feet, to your doctor immediately.
- Inform your doctor or dentist that you are taking Coxitor before any medical or dental procedures.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose to catch up.
Driving Precautions
Etoricoxib may cause dizziness or drowsiness in some individuals. If you experience these symptoms, avoid driving or operating machinery until you know how the medication affects you.
Lifestyle Advice
- Avoid excessive alcohol consumption, especially if you have a history of gastrointestinal issues, as it may increase the risk of stomach irritation and bleeding. Maintain a healthy lifestyle, including regular exercise and a balanced diet, to support overall well-being and pain management.
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