Coxtop
Generic Name
Etoricoxib
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Description
Overview of the medicine
Coxtop (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 conditions like osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and acute gouty arthritis.
Uses & Indications
Dosage
Adults
Osteoarthritis: 30-60 mg once daily. Rheumatoid Arthritis/Ankylosing Spondylitis: 60-90 mg once daily. Acute Gouty Arthritis: 120 mg once daily for up to 8 days. Acute pain: 60-120 mg once daily, as needed. Maximum dose 120 mg/day.
Elderly
No dose adjustment generally required, but caution is advised due to increased risk of adverse effects.
Renal_impairment
Mild to moderate renal impairment: No dose adjustment needed. Severe renal impairment (CrCl <30 mL/min): Not recommended.
How to Take
Coxtop tablets should be swallowed whole with water, with or without food. Taking with food may reduce gastrointestinal upset.
Mechanism of Action
Etoricoxib selectively inhibits cyclooxygenase-2 (COX-2), an enzyme responsible for the synthesis of prostaglandins, which are mediators of pain, inflammation, and fever. By inhibiting COX-2, it reduces the production of these inflammatory prostaglandins, thereby alleviating pain and inflammation, while theoretically preserving gastrointestinal protective COX-1 activity.
Pharmacokinetics
Onset
Pain relief usually within 24 minutes to 1 hour.
Excretion
Excreted predominantly in the urine (70%) and feces (20%) as metabolites.
Half life
Approximately 22 hours.
Absorption
Rapidly and well absorbed from the gastrointestinal tract, with peak plasma concentrations occurring approximately 1 hour after administration.
Metabolism
Extensively metabolized in the liver, primarily by cytochrome P450 (CYP3A4) enzymes, to inactive metabolites.
Side Effects
Contraindications
- Hypersensitivity to etoricoxib or any component of the formulation
- Active peptic ulceration or gastrointestinal bleeding
- Severe liver dysfunction
- Severe uncontrolled heart failure
- Ischaemic heart disease, peripheral arterial disease, cerebrovascular disease
- Previous history of bronchospasm, acute rhinitis, nasal polyps, angioneurotic edema, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
Drug Interactions
Lithium
Increased plasma lithium levels.
Warfarin
Increased risk of bleeding.
Methotrexate
Increased methotrexate toxicity.
Oral contraceptives
Increased plasma concentrations of ethinyl estradiol.
Cyclosporine/Tacrolimus
Increased nephrotoxicity.
Diuretics (e.g., Furosemide) and ACE inhibitors
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
Symptoms of overdose may include gastrointestinal disturbances, somnolence, and lethargy. Management is supportive; there is no specific antidote. Gastric decontamination (e.g., activated charcoal) may be considered if ingestion is recent.
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). Avoid during lactation as it may be excreted in breast milk.
Side Effects
Contraindications
- Hypersensitivity to etoricoxib or any component of the formulation
- Active peptic ulceration or gastrointestinal bleeding
- Severe liver dysfunction
- Severe uncontrolled heart failure
- Ischaemic heart disease, peripheral arterial disease, cerebrovascular disease
- Previous history of bronchospasm, acute rhinitis, nasal polyps, angioneurotic edema, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
Drug Interactions
Lithium
Increased plasma lithium levels.
Warfarin
Increased risk of bleeding.
Methotrexate
Increased methotrexate toxicity.
Oral contraceptives
Increased plasma concentrations of ethinyl estradiol.
Cyclosporine/Tacrolimus
Increased nephrotoxicity.
Diuretics (e.g., Furosemide) and ACE inhibitors
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
Symptoms of overdose may include gastrointestinal disturbances, somnolence, and lethargy. Management is supportive; there is no specific antidote. Gastric decontamination (e.g., activated charcoal) may be considered if ingestion is recent.
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). Avoid during lactation as it may be excreted in breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24 to 36 months from the date of manufacture, depending on storage conditions.
Availability
Pharmacies, hospitals, clinics
Approval Status
Approved
Patent Status
Patent Expired (Generic available)
Clinical Trials
Etoricoxib has been evaluated in numerous clinical trials demonstrating its efficacy in various pain and inflammatory conditions, with a focus on its COX-2 selectivity and comparative safety profile against other NSAIDs.
Lab Monitoring
- Regular monitoring of blood pressure, especially in patients with pre-existing hypertension.
- Periodic monitoring of liver function tests (LFTs) in patients on long-term therapy.
- Kidney function (renal function tests) in patients with pre-existing renal impairment or those at risk.
Doctor Notes
- Counsel patients about cardiovascular and GI risks, especially those with pre-existing conditions.
- Use the lowest effective dose for the shortest duration.
- Consider alternative therapies in high-risk patients.
- Monitor blood pressure and renal function regularly.
Patient Guidelines
- Take the lowest effective dose for the shortest duration necessary.
- Report any signs of gastrointestinal bleeding (black, tarry stools) or cardiovascular events (chest pain, shortness of breath) immediately.
- Do not exceed the recommended dose.
- Inform your doctor about all other medications you are taking, including over-the-counter drugs and herbal supplements.
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
May cause dizziness or drowsiness. Patients should be cautious when driving or operating machinery until they know how Coxtop affects them.
Lifestyle Advice
- Maintain a healthy diet and regular exercise.
- Avoid smoking and excessive alcohol consumption to reduce cardiovascular and gastrointestinal risks.
- Manage underlying conditions like hypertension and diabetes effectively.
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