Coxtop
Generic Name
Etoricoxib
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| coxtop 120 mg tablet | ৳ 14.00 | ৳ 140.00 |
Description
Overview of the medicine
Etoricoxib is a selective COX-2 inhibitor used for the symptomatic relief of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and chronic musculoskeletal pain. It is also used for the treatment of acute gouty arthritis and for moderate acute pain associated with dental surgery.
Uses & Indications
Dosage
Adults
Osteoarthritis: 30 mg or 60 mg once daily. Rheumatoid Arthritis, Ankylosing Spondylitis, Chronic Musculoskeletal Pain: 60 mg or 90 mg once daily. Acute Gouty Arthritis: 120 mg once daily for a maximum of 8 days. Acute Pain associated with Dental Surgery: 90 mg once daily for a maximum of 3 days.
Elderly
No specific dose adjustment is generally required, but use with caution due to increased risk of adverse events in the elderly.
Renal_impairment
Mild to moderate (CrCl 30-80 mL/min): no dose adjustment. Severe (CrCl <30 mL/min): not recommended.
How to Take
Coxtop can be taken orally, with or without food. Taking it with food may reduce gastrointestinal discomfort but may slightly delay absorption.
Mechanism of Action
Etoricoxib selectively inhibits cyclooxygenase-2 (COX-2) enzyme, which is responsible for the synthesis of prostaglandins, mediators of pain, inflammation, and fever. By inhibiting COX-2, etoricoxib reduces the production of these inflammatory mediators.
Pharmacokinetics
Onset
Within 24 minutes for acute pain conditions, longer for chronic inflammatory conditions.
Excretion
Primarily through urine (70%) and feces (20%) as metabolites, with less than 1% excreted unchanged.
Half life
Approximately 22 hours.
Absorption
Rapidly absorbed after oral administration, with peak plasma concentrations (Cmax) achieved in approximately 1 hour.
Metabolism
Extensively metabolized in the liver, primarily by CYP3A4, forming inactive metabolites.
Side Effects
Contraindications
- Hypersensitivity to etoricoxib or any component of the formulation
- Active peptic ulceration or gastrointestinal (GI) bleeding
- Severe hepatic dysfunction
- Severe renal dysfunction (creatinine clearance <30 mL/min)
- Congestive heart failure (NYHA Class II-IV)
- Established ischemic heart disease, peripheral arterial disease, and/or cerebrovascular disease
- Uncontrolled hypertension (blood pressure consistently >140/90 mmHg)
- Pregnancy and lactation
- Children and adolescents under 16 years of age
Drug Interactions
Lithium
Increased plasma lithium levels and potential toxicity.
Warfarin
Increased risk of bleeding due to enhanced anticoagulant effect.
Methotrexate
Increased methotrexate levels and potential toxicity.
Aspirin (low-dose)
While concomitant use with low-dose aspirin for cardiovascular protection is generally acceptable, it may increase the risk of GI side effects. High-dose aspirin should be avoided.
Oral Contraceptives
Increased plasma concentrations of ethinyl estradiol, potentially increasing contraceptive efficacy or side effects.
Cyclosporine, Tacrolimus
Increased nephrotoxicity.
Diuretics, ACE inhibitors, Angiotensin II Antagonists
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 an overdose, symptomatic and supportive treatment should be initiated. There is no specific antidote for etoricoxib. Hemodialysis is unlikely to be effective in removing etoricoxib.
Pregnancy & Lactation
Etoricoxib is contraindicated during pregnancy, especially in the third trimester, due to the potential for premature closure of the fetal ductus arteriosus. It is also contraindicated during lactation as it is excreted in breast milk.
Side Effects
Contraindications
- Hypersensitivity to etoricoxib or any component of the formulation
- Active peptic ulceration or gastrointestinal (GI) bleeding
- Severe hepatic dysfunction
- Severe renal dysfunction (creatinine clearance <30 mL/min)
- Congestive heart failure (NYHA Class II-IV)
- Established ischemic heart disease, peripheral arterial disease, and/or cerebrovascular disease
- Uncontrolled hypertension (blood pressure consistently >140/90 mmHg)
- Pregnancy and lactation
- Children and adolescents under 16 years of age
Drug Interactions
Lithium
Increased plasma lithium levels and potential toxicity.
Warfarin
Increased risk of bleeding due to enhanced anticoagulant effect.
Methotrexate
Increased methotrexate levels and potential toxicity.
Aspirin (low-dose)
While concomitant use with low-dose aspirin for cardiovascular protection is generally acceptable, it may increase the risk of GI side effects. High-dose aspirin should be avoided.
Oral Contraceptives
Increased plasma concentrations of ethinyl estradiol, potentially increasing contraceptive efficacy or side effects.
Cyclosporine, Tacrolimus
Increased nephrotoxicity.
Diuretics, ACE inhibitors, Angiotensin II Antagonists
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 an overdose, symptomatic and supportive treatment should be initiated. There is no specific antidote for etoricoxib. Hemodialysis is unlikely to be effective in removing etoricoxib.
Pregnancy & Lactation
Etoricoxib is contraindicated during pregnancy, especially in the third trimester, due to the potential for premature closure of the fetal ductus arteriosus. It is also contraindicated during lactation as it is excreted in breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24 months from the date of manufacture.
Availability
Pharmacies, Hospitals
Approval Status
Approved
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, and acute gouty arthritis. These trials have evaluated its cardiovascular and gastrointestinal safety profile compared to other NSAIDs.
Lab Monitoring
- Blood pressure monitoring (especially in hypertensive patients)
- Renal function tests (e.g., serum creatinine, BUN) periodically
- Liver function tests (e.g., ALT, AST) periodically
- Complete blood count (CBC) including hemoglobin (to monitor for GI bleeding)
Doctor Notes
- Prescribe the lowest effective dose of etoricoxib for the shortest duration consistent with individual patient treatment goals.
- Monitor blood pressure regularly, especially in patients with pre-existing hypertension or those at risk of cardiovascular events.
- Assess gastrointestinal risk factors before initiating therapy and consider gastroprotective agents if needed.
- Avoid use in patients with significant cardiovascular disease or uncontrolled hypertension.
Patient Guidelines
- Take Coxtop exactly as prescribed by your doctor and do not exceed the recommended dose.
- Report any signs of gastrointestinal bleeding (e.g., black, tarry stools, vomiting blood) or cardiovascular issues (e.g., chest pain, shortness of breath) immediately to your doctor.
- Inform your doctor about all other medications, supplements, and herbal products you are taking.
- Do not use Coxtop for longer than recommended by your doctor, especially for acute 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
Etoricoxib may cause dizziness or drowsiness in some individuals. Patients should be cautious when driving or operating machinery until they know how the medicine affects them.
Lifestyle Advice
- Maintain a healthy and balanced diet to support overall health.
- Engage in regular physical activity as advised by your doctor, especially for joint conditions.
- Avoid smoking and excessive alcohol consumption, as these can increase the risk of gastrointestinal and cardiovascular side effects.
- Regularly monitor your blood pressure if you have a history of hypertension.
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