Etoricoxib (Arcoxia)
Is It Right for You?
A complete guide to Etoricoxib (Arcoxia) — what it treats, how it works, dosages, side effects, and when a clinician may prescribe it following an online consultation.
What Is Etoricoxib (Arcoxia)?
Etoricoxib, marketed as Arcoxia, is a selective cyclo-oxygenase-2 (COX-2) inhibitor — a class of non-steroidal anti-inflammatory drug (NSAID) specifically designed to provide anti-inflammatory, analgesic, and antipyretic effects while minimising the gastrointestinal toxicity associated with traditional non-selective NSAIDs. It is available in tablets of 30 mg, 60 mg, 90 mg, and 120 mg.
Unlike traditional NSAIDs (such as ibuprofen, naproxen, or diclofenac), which inhibit both COX-1 (constitutively expressed in gastric mucosa, platelets, and kidneys) and COX-2 (induced at sites of inflammation), etoricoxib selectively targets COX-2. This selectivity significantly reduces the risk of gastric erosion and ulceration — the principal gastrointestinal harms of traditional NSAIDs — while preserving equivalent anti-inflammatory and analgesic potency.
Etoricoxib is noted for its long half-life of approximately 22 hours, enabling convenient once-daily dosing and sustained 24-hour pain control — a significant practical advantage for patients with chronic inflammatory conditions.
Etoricoxib is a prescription-only medication in the UK. A licensed clinician must assess your cardiovascular risk, renal function, and medical history before it can be prescribed.
What Conditions Is Etoricoxib Used For?
Etoricoxib is indicated for:
relief of pain and inflammation associated with degenerative joint disease
symptom control in active disease; used as part of a broader disease management strategy
treatment of pain and inflammation in this form of inflammatory spinal arthritis
Etoricoxib effectively reduces pain and inflammation but does not slow the progression of rheumatoid arthritis, osteoarthritis, or ankylosing spondylitis. Disease-modifying antirheumatic drugs (DMARDs) for inflammatory arthritis, and weight management and exercise for osteoarthritis, remain the cornerstone of disease management.
How Does Etoricoxib Work?
The cyclo-oxygenase (COX) enzyme system exists in two principal isoforms with distinct physiological roles:
COX-1 is constitutively expressed throughout the body, particularly in gastric mucosa (where it produces protective prostaglandins), platelets (where it supports thromboxane-mediated aggregation), and kidneys. Non-selective NSAIDs inhibit COX-1, which explains their propensity to cause gastric ulcers, impair platelet function, and affect renal blood flow.
COX-2 is an inducible isoform, upregulated at sites of tissue injury and inflammation in response to inflammatory stimuli such as cytokines. It catalyses the conversion of arachidonic acid to prostaglandins — the lipid mediators responsible for vasodilation, increased vascular permeability, sensitisation of pain receptors, and fever.
Etoricoxib selectively inhibits COX-2 with high specificity, suppressing the production of inflammatory prostaglandins at sites of injury without significantly inhibiting the gastroprotective and platelet functions of COX-1. This selectivity translates to equivalent anti-inflammatory and analgesic efficacy compared to non-selective NSAIDs but with significantly lower rates of upper gastrointestinal ulceration and serious GI events.
Dosages & Administration
The correct dose depends on the type and severity of infection, age, weight, and kidney function. Always follow your clinician's instructions. The table below is for general reference only.
Administration Tips
Always follow your clinician's instructions. Use the lowest effective dose for the shortest duration necessary. Take etoricoxib at the same time each day. Its 22-hour half-life means once-daily dosing provides consistent pain coverage throughout the 24-hour period. Can be taken with or without food. Food does not significantly affect absorption. Use the lowest dose that controls your symptoms. For osteoarthritis, the 30 mg dose is often sufficient and minimises cardiovascular and renal exposuTake etoricoxib at the same time each day. Its 22-hour half-life means once-daily dosing provides consistent pain coverage throughout the 24-hour period.
Can be taken with or without food. Food does not significantly affect absorption.
Use the lowest dose that controls your symptoms. For osteoarthritis, the 30 mg dose is often sufficient and minimises cardiovascular and renal exposure. Escalate to higher doses only if lower doses are inadequate and only under clinical review.
Do not exceed the recommended dose or duration for acute indications (maximum 8 days for the 120 mg dose for gout and acute pain).
Do not take etoricoxib alongside other NSAIDs — additive risk of gastrointestinal and cardiovascular side effects without additional therapeutic benefit.re. Escalate to higher doses only if lower doses are inadequate and only under clinical review. Do not exceed the recommended dose or duration for acute indications (maximum 8 days for the 120 mg dose for gout and acute pain). Do not take etoricoxib alongside other NSAIDs — additive risk of gastrointestinal and cardiovascular side effects without additional therapeutic benefit.
Side Effects of Etoricoxib
Most side effects are mild and resolve on their own. Serious side effects are rare but require immediate medical attention.
- Hypertension (raised blood pressure) — one of the most common; monitor blood pressure regularly
- Peripheral oedema (fluid retention, ankle swelling)
- Dyspepsia, nausea, or abdominal discomfort
- Headache
- Dizziness
- Fatigue
- Liver enzyme elevation (transaminase rises) — usually mild and reversible
- Myocardial infarction or stroke — COX-2 inhibitors are associated with an increased risk of thrombotic cardiovascular events; chest pain, arm pain, sudden severe headache, facial droop, arm weakness, speech disturbance
- Serious gastrointestinal events — peptic ulceration, perforation, or gastrointestinal bleeding; risk lower than non-selective NSAIDs but still present; black or bloody stools, severe abdominal pain, vomiting blood
- Severe hepatotoxicity — jaundice, right upper abdominal pain, dark urine; rare
- Acute kidney injury — particularly in volume-depleted patients or those with pre-existing renal impairment
- Severe hypertension — including hypertensive crisis
- Severe allergic reaction / anaphylaxis
- Serious skin reactions — Stevens-Johnson Syndrome; rare
All COX-2 selective inhibitors increase the risk of thrombotic cardiovascular events — including myocardial infarction and stroke — particularly with long-term use and in patients with pre-existing cardiovascular risk factors. Etoricoxib is contraindicated in patients with established ischaemic heart disease, stroke, peripheral arterial disease, or uncontrolled hypertension. The lowest effective dose for the shortest duration is always the guiding principle.
Drug Interactions
Etoricoxib may interact with other medications, including MAOIs, CNS depressants, and strong CYP2D6 inhibitors. Always inform your clinician about all medications you are taking.
Etoricoxib increases the anticoagulant effect of warfarin; INR can rise significantly. Monitor INR closely at initiation and following dose changes.
NSAIDs including COX-2 inhibitors reduce lithium renal clearance, raising plasma lithium levels and risk of toxicity; monitor lithium levels closely.
NSAIDs reduce methotrexate renal clearance; risk of methotrexate toxicity particularly at oncological doses.
Etoricoxib reduces the antihypertensive and diuretic effects of these agents and increases the risk of acute renal failure — particularly in volume-depleted or elderly patients. Monitor renal function and blood pressure.
Important Warnings
Etoricoxib is contraindicated in patients with established ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, or uncontrolled hypertension. All COX-2 inhibitors carry a class-level increased risk of thrombotic cardiovascular events. The cardiovascular risk must be carefully assessed before prescribing, and the lowest effective dose used for the shortest duration.
Etoricoxib commonly raises blood pressure, which can increase cardiovascular risk. Blood pressure should be monitored at baseline and during treatment. Patients with hypertension that becomes poorly controlled should discontinue etoricoxib and seek review.
Etoricoxib is contraindicated in patients with severe renal impairment (eGFR <30 mL/min). All NSAIDs — including selective COX-2 inhibitors — reduce renal prostaglandin synthesis, potentially causing vasoconstriction of the afferent arteriole and acute kidney injury, particularly in volume-depleted patients.
Although the GI risk is lower than with non-selective NSAIDs, serious upper GI events (ulceration, bleeding, perforation) can still occur with etoricoxib. GI protective therapy (a proton pump inhibitor) should be co-prescribed in patients with GI risk factors — including older age, history of peptic ulcer, or concurrent aspirin use.
Speak to a Clinician About Treatment
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The treatment you need, when you need it.
Etoricoxib FAQs
Yes — etoricoxib's COX-2 selectivity means it is significantly less likely to cause gastric ulceration and serious upper GI bleeding than non-selective NSAIDs such as ibuprofen, naproxen, or diclofenac. However, it is not entirely risk-free, and GI protection with a proton pump inhibitor is recommended in higher-risk patients.
Etoricoxib commonly raises blood pressure and is contraindicated in uncontrolled hypertension. Patients with well-controlled hypertension should have blood pressure monitored during treatment. If blood pressure becomes difficult to control, etoricoxib should be stopped.
Etoricoxib is rapidly absorbed, with plasma levels peaking within 1 hour. Pain relief is typically noticeable within the first dose for acute conditions. For chronic inflammatory conditions, fuller benefit develops over several days of regular dosing.
Yes — paracetamol and etoricoxib work by different mechanisms and can be used concurrently safely. Combining them is often more effective for pain management than either drug alone.
Although etoricoxib carries a lower GI risk than non-selective NSAIDs, patients with risk factors for peptic ulcer disease (older age, previous ulcer history, concurrent aspirin use) benefit from co-prescribing a PPI (such as omeprazole or lansoprazole) to protect the gastric lining.