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 90 mg tablet | ৳ 12.00 | ৳ 120.00 |
Description
Overview of the medicine
Coxtop 90 mg Tablet contains Etoricoxib, a selective COX-2 inhibitor, used to relieve pain and inflammation in various conditions like osteoarthritis, rheumatoid arthritis, and acute gout.
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/Primary Dysmenorrhea: 90 mg once daily for a maximum of 3 days.
Elderly
No dosage adjustment is generally required, but caution should be exercised due to increased risk of side effects.
Renal_impairment
Mild to moderate renal impairment (creatinine clearance 30-80 ml/min): No adjustment needed. Severe renal impairment (creatinine clearance <30 ml/min): Not recommended.
How to Take
Take Coxtop 90 mg Tablet orally, with or without food. Swallow the tablet whole with a glass of water. Do not crush, chew, or break the tablet.
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 pain and inflammation without significantly affecting COX-1, which is involved in gastric protection.
Pharmacokinetics
Onset
Pain relief usually starts within 1-2 hours.
Excretion
Excreted predominantly via the kidneys (70%) and feces (20%) as metabolites.
Half life
Approximately 22 hours.
Absorption
Rapidly absorbed after oral administration. Peak plasma concentrations (Cmax) are reached approximately 1 hour post-dose.
Metabolism
Extensively metabolized in the liver, primarily by cytochrome P450 (CYP) enzymes, mainly CYP3A4. Metabolites are largely inactive.
Side Effects
Contraindications
- Hypersensitivity to etoricoxib or any component of the tablet
- Active peptic ulceration or gastrointestinal bleeding
- History of bronchospasm, acute rhinitis, nasal polyps, angioneurotic edema, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
- 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
Drug Interactions
Lithium
Etoricoxib may increase plasma lithium levels.
Warfarin
Increased prothrombin time/INR, leading to increased bleeding risk.
Diuretics
May reduce the natriuretic effect of loop and thiazide diuretics.
Methotrexate
May increase plasma methotrexate concentrations and its toxicity.
Cyclosporine/Tacrolimus
May increase the nephrotoxicity of cyclosporine and tacrolimus.
ACE Inhibitors/Angiotensin Receptor Blockers (ARBs)
May reduce the antihypertensive effect and increase the 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, symptoms may include gastrointestinal disturbances (e.g., nausea, vomiting, abdominal pain), somnolence, and rarely, acute renal failure. Treatment is symptomatic and supportive, including gastric decontamination if necessary. Hemodialysis is unlikely to be effective.
Pregnancy & Lactation
Pregnancy Category C in early pregnancy, changing to D in the third trimester. Not recommended during pregnancy, especially in the third trimester due to potential adverse effects on the fetal cardiovascular system. Avoid during lactation as it is excreted in breast milk.
Side Effects
Contraindications
- Hypersensitivity to etoricoxib or any component of the tablet
- Active peptic ulceration or gastrointestinal bleeding
- History of bronchospasm, acute rhinitis, nasal polyps, angioneurotic edema, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
- 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
Drug Interactions
Lithium
Etoricoxib may increase plasma lithium levels.
Warfarin
Increased prothrombin time/INR, leading to increased bleeding risk.
Diuretics
May reduce the natriuretic effect of loop and thiazide diuretics.
Methotrexate
May increase plasma methotrexate concentrations and its toxicity.
Cyclosporine/Tacrolimus
May increase the nephrotoxicity of cyclosporine and tacrolimus.
ACE Inhibitors/Angiotensin Receptor Blockers (ARBs)
May reduce the antihypertensive effect and increase the 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, symptoms may include gastrointestinal disturbances (e.g., nausea, vomiting, abdominal pain), somnolence, and rarely, acute renal failure. Treatment is symptomatic and supportive, including gastric decontamination if necessary. Hemodialysis is unlikely to be effective.
Pregnancy & Lactation
Pregnancy Category C in early pregnancy, changing to D in the third trimester. Not recommended during pregnancy, especially in the third trimester due to potential adverse effects on the fetal cardiovascular system. Avoid during lactation as it is excreted in breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2 to 3 years from the date of manufacture. Check the expiry date on the packaging.
Availability
Available in pharmacies nationwide
Approval Status
Approved by DGDA (Bangladesh)
Patent Status
Generic available, Brand name Coxtop is patented
Clinical Trials
Etoricoxib has undergone extensive clinical trials demonstrating its efficacy in managing various painful and inflammatory conditions, with a focus on its COX-2 selectivity and cardiovascular safety profile compared to non-selective NSAIDs.
Lab Monitoring
- Blood pressure monitoring, especially in hypertensive patients.
- Renal function tests (e.g., serum creatinine, BUN) periodically, especially in elderly or renally impaired patients.
- Liver function tests (e.g., ALT, AST) if liver dysfunction is suspected or during prolonged therapy.
- Complete blood count (CBC) occasionally, as NSAIDs can rarely cause blood dyscrasias.
Doctor Notes
- Consider the patient's cardiovascular and gastrointestinal risk factors before prescribing and during treatment.
- Use the lowest effective dose for the shortest possible duration consistent with individual patient treatment goals.
- Monitor blood pressure regularly, especially at the start of treatment and during dose escalation.
Patient Guidelines
- Take exactly as prescribed by your doctor; do not exceed the recommended dose or duration of treatment.
- Report any unusual bleeding, persistent stomach upset, swelling, or changes in blood pressure to your doctor immediately.
- Do not take with other NSAIDs (including aspirin) without consulting your doctor.
- Be aware of potential cardiovascular and gastrointestinal risks, especially with long-term use.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not double the dose to make up for a missed one.
Driving Precautions
Etoricoxib may cause dizziness, somnolence, or blurred vision. If you experience these effects, avoid driving or operating machinery.
Lifestyle Advice
- Maintain a healthy diet and engage in regular, moderate exercise to support overall joint health.
- Limit alcohol consumption, as it may increase the risk of gastrointestinal side effects when taken with etoricoxib.
- Avoid smoking, as it is a risk factor for cardiovascular disease and may worsen conditions for which etoricoxib is prescribed.
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