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Etoricoxib ( Arcoxia ) is a selective COX-2 inhibitor from Merck & Co. Currently it is approved in more than 80 countries worldwide but not in the US, where the Food and Drug Administration (FDA) has required additional safety and efficacy data for etoricoxib before it will issue approval.
1 Therapeutic indications
2 Mechanism of action
3 Adverse effects
5 Brand names
Etoricoxib is indicated for the treatment of rheumatoid arthritis, psoriatic arthritis, osteoarthritis, ankylosing spondylitis, chronic low back pain, acute pain, and gout. Approved indications differ by country.
A Cochrane systematic review assessed the benefits of single-dose etoricoxib in reduction of acute post-operative pain in adults.
Mechanism of action
Like any other selective COX-2 inhibitor (“coxib”), etoricoxib selectively inhibits isoform 2 of the enzyme cyclooxygenase (COX-2). It has approximately 106-fold selectivity for COX-2 inhibition over COX-1. This reduces the generation of prostaglandins (PGs) from arachidonic acid. Among the different functions exerted by PGs, their role in the inflammation cascade should be highlighted.
Selective COX-2 inhibitors show less activity on COX-1 compared to traditional non-steroidal anti-inflammatory drugs (NSAID). This reduced activity is the cause of reduced gastrointestinal side effects, as demonstrated in several large clinical trials performed with different coxibs.
Like all other NSAIDs the COX-2 inhibitors too have their share of adverse effects. Fixed drug eruption and generalised erythema, are some serious side effects reported, besides the usual innocuous ones.
Some clinical trials and meta-analysis showed that treatment with some coxibs (in particular rofecoxib ) led to increased incidence of adverse cardiovascular events compared to placebo. Because of these results, some drugs were withdrawn from the market (rofecoxib, in September 2004 and valdecoxib in April 2005). In addition, the United States Food and Drug Administration and the European Medicines Agency started revision processes of the entire class of both NSAIDs and COX-2 inhibitors.
In April 2007, the FDA issued Merck a non-approvable letter for etoricoxib. The letter said Merck needs to provide more test results showing that the drug’s benefits outweigh its risks before it has another chance of getting approved.
Brand names for etoricoxib include:
Arcoxia in Spain, Portugal, Saudi Arabia, Sweden, Finland, Norway, Estonia, Germany, Greece, Lithuania, Chile, China, Hong Kong, Hungary, Indonesia, Ireland, Israel, Jordan, Lebanon, Brazil, Malaysia, Singapore, Thailand, Guatemala, Mexico, Bulgaria, Costa Rica, Philippines, Ecuador, Australia, New Zealand, Romania, South Africa, Trinidad & Tobago, United Arab Emirates, United Kingdom, Ukraine, Russian Federation, Netherlands, Croatia, and Panama
Algix and Tauxib in Italy
Etorix, Eto, Tory, Etoxib, and Vargus in Bangladesh and Costa Rica
Arcox, Berrica, and Starcox in Pakistan
Exxiv in Portugal
Etozox, Etospeed, Intacoxia, Nucoxia, ETOS MR, and Etoshine in India
Coxit in Jordan
E-Cox and Vecoxib in Nepal
Hetori in Brazi
Etoll in India
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