Selective COX-2 inhibitor (coxib)
ATC code: M01AH05 (Etoricoxib)
Brand names
Arcoxia, Algix, Tauxib, Exxiv
A highly selective reversible COX-2 inhibitor with COX-2/COX-1 ratio of about 106:1 in vitro. Reduces pro-inflammatory prostaglandin synthesis at the inflammation site without blocking gastric COX-1 – less gastroduodenal erosion and ulcer risk than non-selective NSAIDs. Half-life 22 hours allows once-daily dosing. Not -approved in the US due to cardiovascular risk; widely prescribed in Europe and Latin America.
Second line
Symptomatic treatment of knee and hip osteoarthritis when pain persists despite paracetamol and topical NSAIDs. 2019 and 2023 set topical NSAIDs and paracetamol as first-line pharmacotherapy for osteoarthritis; oral NSAIDs including coxibs are second-line with shortest possible duration. Dose 30–60 mg daily.
Second line
Used for symptomatic relief in rheumatoid arthritis as an alternative to non-selective NSAIDs in patients at high gastrointestinal risk (ulcer history, age over 65, combination with anticoagulants or steroids). Does not modify disease course – 2022 builds treatment around DMARDs (methotrexate, sulfasalazine, leflunomide) plus biologics when needed. RA dose: 60–90 mg once daily.
Second line
Used in acute pain (dental, postoperative, musculoskeletal) in courses up to 8 days. Dose 90–120 mg once daily. Efficacy is comparable to ibuprofen 600 mg four times daily with better GI tolerability.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Etoricoxib is a selective cyclooxygenase-2 inhibitor (coxib). It is prescribed for osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and gout (AEMPS Ficha Técnica). In anti-aging regimens, etoricoxib is positioned as a selective coxib without ulcer risks for long-term suppression of low-grade aging-related inflammation. Long-term use in people without a confirmed inflammatory disease is not justified: 2020 and 2023 do not include NSAIDs in age-related prevention. COX-2 selectivity reduces GI bleeding risk but raises cardiovascular risk: the MEDAL 2007 meta-analysis showed that etoricoxib is associated with greater blood-pressure elevation and heart-failure risk than nonselective NSAIDs. If etoricoxib was prescribed for chronic anti-inflammatory use, consider seeking a second opinion.
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Contraindicated in T3 – risk of premature ductus arteriosus closure, oligohydramnios, and fetal renal dysfunction. T1 and T2 use is not recommended without clear indication.
Limited data. Ibuprofen with more data is preferred during lactation.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Etoricoxib is evaluated for the following indications with varying evidence strength: Rheumatoid arthritis (evidence tier A), Knee osteoarthritis (evidence tier A), Acute mild-to-moderate pain (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of Etoricoxib (≥ 1 in 100): Elevated blood pressure, Edema, Dizziness, Headache, Dyspepsia, nausea, Elevated liver enzymes. See the Safety section for uncommon and serious reactions.
FDA category C. Contraindicated in T3 – risk of premature ductus arteriosus closure, oligohydramnios, and fetal renal dysfunction. T1 and T2 use is not recommended without clear indication.
Limited data. Ibuprofen with more data is preferred during lactation.
Etoricoxib is contraindicated in: Hypersensitivity to etoricoxib or other coxibs; Active peptic ulcer, GI bleeding; Inflammatory bowel disease; Severe hepatic impairment; Renal impairment with eGFR under 30. Full list in the Safety section.