Coxsafe
Generic Name
Etoricoxib
Manufacturer
Incepta Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| coxsafe 90 mg tablet | ৳ 12.00 | ৳ 120.00 |
Description
Overview of the medicine
Etoricoxib is a non-steroidal anti-inflammatory drug (NSAID) belonging to the COX-2 selective inhibitor class. It is used to relieve pain and inflammation in conditions like osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and acute gouty arthritis.
Uses & Indications
Dosage
Adults
For Rheumatoid Arthritis and Ankylosing Spondylitis: 90 mg once daily. For acute pain, primary dysmenorrhea, or post-dental surgery pain: 90 mg once daily for a maximum of 3 days. For acute gouty arthritis: 120 mg once daily for a maximum of 8 days (if 90 mg is prescribed, discuss with physician).
Elderly
No dose adjustment generally required, but caution is advised. Lowest effective dose should be used.
Renal_impairment
Mild to moderate renal impairment: No dose 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.
Mechanism of Action
Etoricoxib selectively inhibits cyclooxygenase-2 (COX-2) enzyme, which is responsible for the synthesis of prostaglandins, mediators of pain and inflammation. By inhibiting COX-2, it reduces prostaglandin production, thereby alleviating pain and inflammation.
Pharmacokinetics
Onset
Within 24 minutes for acute pain, within 1-2 hours for chronic pain conditions.
Excretion
Mainly excreted in urine (70%) and feces (20%) as metabolites.
Half life
Approximately 22 hours.
Absorption
Rapidly and well absorbed from the gastrointestinal tract. Peak plasma concentrations are reached in approximately 1 hour.
Metabolism
Extensively metabolized by cytochrome P450 enzymes (mainly CYP3A4) in the liver to inactive metabolites.
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)
- Congestive heart failure (NYHA Class II-IV)
- Established ischaemic heart disease, peripheral arterial disease, and/or cerebrovascular disease
- Third trimester of pregnancy
Drug Interactions
Lithium
Increased plasma levels of lithium, leading to toxicity.
Methotrexate
Increased plasma levels of methotrexate, leading to toxicity.
Oral contraceptives
Increased exposure to ethinyl estradiol.
Cyclosporine, Tacrolimus
Increased nephrotoxicity risk.
ACE inhibitors/ARBs/Diuretics
Reduced antihypertensive effect, increased risk of renal impairment.
Warfarin and other anticoagulants
Increased risk of bleeding.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include gastrointestinal disturbances (e.g., abdominal pain, nausea, vomiting), renal toxicity, and, rarely, severe hypertension. Management is symptomatic and supportive. Gastric lavage or activated charcoal may be considered within the first hour of ingestion.
Pregnancy & Lactation
Pregnancy: Contraindicated in the third trimester. Use in first and second trimesters should be avoided unless clearly necessary, with the lowest effective dose for the shortest duration. May impair female fertility. Lactation: Etoricoxib is excreted in the milk of lactating rats, and it is unknown whether it is excreted in human milk. A decision must be made whether to discontinue breastfeeding or discontinue the drug, taking into account the benefit of breastfeeding for the child and the benefit of therapy for the woman.
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)
- Congestive heart failure (NYHA Class II-IV)
- Established ischaemic heart disease, peripheral arterial disease, and/or cerebrovascular disease
- Third trimester of pregnancy
Drug Interactions
Lithium
Increased plasma levels of lithium, leading to toxicity.
Methotrexate
Increased plasma levels of methotrexate, leading to toxicity.
Oral contraceptives
Increased exposure to ethinyl estradiol.
Cyclosporine, Tacrolimus
Increased nephrotoxicity risk.
ACE inhibitors/ARBs/Diuretics
Reduced antihypertensive effect, increased risk of renal impairment.
Warfarin and other anticoagulants
Increased risk of bleeding.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include gastrointestinal disturbances (e.g., abdominal pain, nausea, vomiting), renal toxicity, and, rarely, severe hypertension. Management is symptomatic and supportive. Gastric lavage or activated charcoal may be considered within the first hour of ingestion.
Pregnancy & Lactation
Pregnancy: Contraindicated in the third trimester. Use in first and second trimesters should be avoided unless clearly necessary, with the lowest effective dose for the shortest duration. May impair female fertility. Lactation: Etoricoxib is excreted in the milk of lactating rats, and it is unknown whether it is excreted in human milk. A decision must be made whether to discontinue breastfeeding or discontinue the drug, taking into account the benefit of breastfeeding for the child and the benefit of therapy for the woman.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24-36 months from manufacturing date.
Availability
Pharmacies nationwide
Approval Status
Approved
Patent Status
Generic available
Clinical Trials
Extensive clinical trials have demonstrated etoricoxib's efficacy and safety in various inflammatory conditions. Specific trials like MEDAL demonstrated non-inferiority to diclofenac in cardiovascular safety, but showed higher rates of hypertension.
Lab Monitoring
- Blood pressure monitoring
- Liver function tests (LFTs)
- Renal function tests (RFTs) especially in long-term use
Doctor Notes
- Assess cardiovascular risk factors before prescribing, and monitor blood pressure during treatment.
- Use the lowest effective dose for the shortest possible duration.
- Monitor for signs of GI bleeding or ulceration.
Patient Guidelines
- Do not exceed the recommended dose.
- Report any symptoms of stomach pain, black stools, or unusual bleeding/bruising to your doctor immediately.
- Be aware of potential cardiovascular risks, especially if you have heart conditions.
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 continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
May cause dizziness or drowsiness. Patients should be cautioned about operating machinery or driving until they are reasonably certain that etoricoxib does not adversely affect their ability to perform such activities.
Lifestyle Advice
- Maintain a healthy lifestyle, including regular exercise and a balanced diet.
- Avoid smoking and excessive alcohol consumption, as these can increase the risk of gastrointestinal adverse effects.
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