Coxsafe
Generic Name
Etoricoxib
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| coxsafe 60 mg tablet | ৳ 7.00 | ৳ 70.00 |
Description
Overview of the medicine
Etoricoxib is a non-steroidal anti-inflammatory drug (NSAID) that selectively inhibits cyclooxygenase-2 (COX-2). It is used to relieve pain and inflammation associated with various conditions such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute gouty arthritis, and for the short-term treatment of moderate acute pain and primary dysmenorrhea.
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 for a maximum of 8 days. Acute Pain (dental surgery)/Primary Dysmenorrhea: 60-120 mg once daily, not exceeding 8 days.
Elderly
No dosage adjustment is generally required for elderly patients, but use with caution due to increased risk of adverse effects.
Renal_impairment
Mild renal impairment (CrCl 30-80 ml/min): No dosage adjustment. Severe renal impairment (CrCl <30 ml/min): Not recommended.
How to Take
Take orally, with or without food. Swallow the tablet whole with a glass of water. Do not crush or chew.
Mechanism of Action
Etoricoxib is a selective cyclooxygenase-2 (COX-2) inhibitor. It reduces the synthesis of prostaglandins, which are mediators of pain, inflammation, and fever, by inhibiting the COX-2 enzyme. Unlike non-selective NSAIDs, it exhibits minimal inhibition of COX-1, thereby potentially reducing gastrointestinal side effects.
Pharmacokinetics
Onset
Pain relief may be seen as early as 24 minutes for acute pain conditions.
Excretion
Approximately 70% of the dose is excreted in the urine (as metabolites) and 20% in the feces (as metabolites and unchanged drug).
Half life
The elimination half-life is approximately 22 hours, allowing for once-daily dosing.
Absorption
Rapidly absorbed orally, with a mean oral bioavailability of approximately 100%. Peak plasma concentrations (Cmax) are reached in approximately 1 hour.
Metabolism
Extensively metabolized in the liver, primarily via cytochrome P450 (CYP) enzymes, particularly CYP3A4. Major metabolites are inactive.
Side Effects
Contraindications
- Hypersensitivity to etoricoxib or any component of the tablet
- Active peptic ulceration or gastrointestinal bleeding
- Severe hepatic dysfunction
- Severe renal dysfunction (creatinine clearance <30 ml/min)
- Inflammatory bowel disease
- Congestive heart failure (NYHA II-IV)
- Established ischemic heart disease, peripheral arterial disease, and/or cerebrovascular disease
- Uncontrolled hypertension (blood pressure consistently >140/90 mmHg)
Drug Interactions
Lithium
Increased plasma levels of lithium, potentially leading to lithium toxicity.
Warfarin
Increased risk of bleeding. Close monitoring of INR is required.
Diuretics
Reduced diuretic and antihypertensive effects, increased risk of renal impairment.
Rifampicin
May decrease etoricoxib plasma concentrations.
Methotrexate
Increased plasma concentration of methotrexate, potentially increasing toxicity.
Oral Contraceptives
Increased plasma concentrations of estrogen, potentially increasing risk of adverse effects.
ACE Inhibitors / Angiotensin II Receptor Blockers (ARBs)
Reduced antihypertensive effect and 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 due to high protein binding.
Pregnancy & Lactation
Pregnancy Category C (first two trimesters), D (third trimester). Not recommended during pregnancy, especially in the third trimester due to potential premature closure of the ductus arteriosus and effects on fetal renal function. Should not be used by breastfeeding mothers as etoricoxib is excreted in breast milk.
Side Effects
Contraindications
- Hypersensitivity to etoricoxib or any component of the tablet
- Active peptic ulceration or gastrointestinal bleeding
- Severe hepatic dysfunction
- Severe renal dysfunction (creatinine clearance <30 ml/min)
- Inflammatory bowel disease
- Congestive heart failure (NYHA II-IV)
- Established ischemic heart disease, peripheral arterial disease, and/or cerebrovascular disease
- Uncontrolled hypertension (blood pressure consistently >140/90 mmHg)
Drug Interactions
Lithium
Increased plasma levels of lithium, potentially leading to lithium toxicity.
Warfarin
Increased risk of bleeding. Close monitoring of INR is required.
Diuretics
Reduced diuretic and antihypertensive effects, increased risk of renal impairment.
Rifampicin
May decrease etoricoxib plasma concentrations.
Methotrexate
Increased plasma concentration of methotrexate, potentially increasing toxicity.
Oral Contraceptives
Increased plasma concentrations of estrogen, potentially increasing risk of adverse effects.
ACE Inhibitors / Angiotensin II Receptor Blockers (ARBs)
Reduced antihypertensive effect and 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 due to high protein binding.
Pregnancy & Lactation
Pregnancy Category C (first two trimesters), D (third trimester). Not recommended during pregnancy, especially in the third trimester due to potential premature closure of the ductus arteriosus and effects on fetal renal function. Should not be used by breastfeeding mothers as etoricoxib is excreted in breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
2-3 years (check product specific packaging)
Availability
Available in pharmacies nationwide
Approval Status
Approved (DGDA, FDA in certain indications)
Patent Status
Generic versions available
Clinical Trials
Etoricoxib has undergone extensive clinical trials demonstrating its efficacy in pain and inflammation management across various indications. Studies have also evaluated its cardiovascular and gastrointestinal safety profile compared to other NSAIDs.
Lab Monitoring
- Blood pressure monitoring
- Liver function tests (ALT, AST)
- Renal function tests (Creatinine, GFR)
Doctor Notes
- Assess patient's cardiovascular and gastrointestinal risk factors before prescribing etoricoxib.
- Use the lowest effective dose for the shortest possible duration to achieve treatment goals.
- Monitor blood pressure regularly, especially in patients with pre-existing hypertension.
- Advise patients to report any signs of GI bleeding (e.g., black stools) or cardiovascular events (e.g., chest pain) immediately.
Patient Guidelines
- Take the tablet exactly as prescribed by your doctor.
- Do not exceed the recommended dose or duration of treatment.
- Inform your doctor if you experience any unusual symptoms or side effects.
- Do not take other NSAIDs or aspirin with Etoricoxib without consulting your doctor.
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 take a double dose to make up for a missed one.
Driving Precautions
Etoricoxib may cause dizziness, vertigo, or drowsiness. If you experience these effects, avoid driving or operating machinery.
Lifestyle Advice
- Monitor your blood pressure regularly, especially if you have a history of hypertension.
- Limit alcohol intake, as it may increase the risk of stomach problems when taken with NSAIDs.
- Maintain a healthy lifestyle with balanced diet and regular exercise.
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