.dyspnoea.flushing.haemorrhage.hallucination.
hyperkalaemia.hypersensitivity.insomnia.irritable
bowel syndrome.leucopenia.myocardial infarction.
pancreatitis.proteinuria.renal failure (more common in
patients with pre-existing renal impairment).sensation
abnormal.taste altered.thrombocytopenia.tinnitus.
vasculitis.vertigo.vision blurred.weight increased
▶Rare or very rareAngioedema.confusion.hepatic
disorders.muscle complaints.severe cutaneous adverse
reactions (SCARs).shock
▶Frequency not knownNephritis tubulointerstitial.
nephropathy
SIDE-EFFECTS, FURTHER INFORMATIONFor information
about cardiovascular and gastrointestinal side-effects, and
a possible exacerbation of symptoms in asthma, see Non-
steroidal anti-inflammatory drugs p. 650.
lALLERGY AND CROSS-SENSITIVITYContra-indicated in
patients with a history of hypersensitivity to aspirin or any
other NSAID—which includes those in whom attacks of
asthma, angioedema, urticaria or rhinitis have been
precipitated by aspirin or any other NSAID.
lCONCEPTION AND CONTRACEPTIONCaution—long-term
use of some NSAIDs is associated with reduced female
fertility, which is reversible on stopping treatment.
lPREGNANCYManufacturer advises avoid (teratogenic in
animalstudies). Avoid during the third trimester (risk of
closure of fetal ductus arteriosusin uteroand possibly
persistent pulmonary hypertension of the newborn); onset
of labour may be delayed and duration may be increased.
lBREAST FEEDINGUse with caution during breast-feeding.
Manufacturer advises avoid—present in milk inanimal
studies.
lHEPATIC IMPAIRMENTUse with caution; there is an
increased risk of gastro-intestinal bleeding andfluid
retention. Avoid in severe liver disease.
Dose adjustmentsMax. 60 mg daily in mild impairment.
Max. 60 mg on alternate days or 30 mg once daily in
moderate impairment.
lRENAL IMPAIRMENTAvoid if possible or use with caution.
Avoid if estimated glomerularfiltration rate less than
30 mL/minute/ 1. 73 m^2.
Dose adjustmentsThe lowest effective dose should be used
for the shortest possible duration.
MonitoringIn renal impairment monitor renal function;
sodium and water retention may occur and renal function
may deteriorate, possibly leading to renal failure.
lMONITORING REQUIREMENTSMonitor blood pressure
before treatment, 2 weeks after initiation and periodically
during treatment.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Tablet
▶Etoricoxib (Non-proprietary)
Etoricoxib 30 mgEtoricoxib 30 mg tablets| 28 tabletP£ 2. 80 –
£ 13. 99 DT = £ 13. 99
Etoricoxib 60 mgEtoricoxib 60 mg tablets| 28 tabletP£ 3. 01 –
£ 20. 11 DT = £ 3. 01
Etoricoxib 90 mgEtoricoxib 90 mg tablets| 28 tabletP£ 3. 64 –
£ 22. 96 DT = £ 3. 64
Etoricoxib 120 mgEtoricoxib 120 mg tablets| 7 tabletP£ 1. 80 –
£ 5. 73 | 28 tabletP£ 7. 23 – £ 24. 11 DT = £ 24. 11
▶Arcoxia(Grunenthal Ltd)
Etoricoxib 30 mgArcoxia 30 mg tablets| 28 tabletP£ 13. 99 DT
=£ 13. 99
Etoricoxib 60 mgArcoxia 60 mg tablets| 28 tabletP£ 20. 11 DT
=£ 3. 01
Etoricoxib 90 mgArcoxia 90 mg tablets| 5 tabletP£ 4. 10 |
28 tabletP£ 22. 96 DT = £ 3. 64
Etoricoxib 120 mgArcoxia 120 mg tablets| 7 tabletP£ 6. 03 |
28 tabletP£ 24. 11 DT = £ 24. 11Flurbiprofen
lINDICATIONS AND DOSE
Pain and inflammation in rheumatic disease and other
musculoskeletal disorders|Migraine|Postoperative
analgesia|Mild to moderate pain
▶BY MOUTH
▶Child 12–17 years: 150 – 200 mg daily in 2 – 4 divided
doses, then increased to 300 mg daily, dose to be
increased only in acute conditions
Dysmenorrhoea
▶BY MOUTH
▶Child 12–17 years:Initially 100 mg, then 50 – 100 mg
every 4 – 6 hours; maximum 300 mg per daylCONTRA-INDICATIONSActive gastro-intestinal bleeding.
active gastro-intestinal ulceration.history of gastro-
intestinal bleeding related to previous NSAID therapy.
history of gastro-intestinal perforation related to previous
NSAID therapy.history of recurrent gastro-intestinal
haemorrhage (two or more distinct episodes).history of
recurrent gastro-intestinal ulceration (two or more
distinct episodes).severe heart failure
lCAUTIONSAllergic disorders.cardiac impairment (NSAIDs
may impair renal function).cerebrovascular disease.
coagulation defects.connective-tissue disorders.Crohn’s
disease (may be exacerbated).heart failure.ischaemic
heart disease.peripheral arterial disease.risk factors for
cardiovascular events.ulcerative colitis (may be
exacerbated).uncontrolled hypertension
lINTERACTIONS→Appendix 1 : NSAIDs
lSIDE-EFFECTS
▶Common or very commonHaemorrhage
▶Frequency not knownAgranulocytosis.angioedema.
aplastic anaemia.asthma.bronchospasm.confusion.
constipation.Crohn’s disease.depression.diarrhoea.
dizziness.drowsiness.dyspnoea.fatigue.fertility
decreased female.gastrointestinal discomfort.
gastrointestinal disorders.haemolytic anaemia.
hallucination.headache.heart failure.hepatic disorders.
hypersensitivity.hypertension.malaise.meningitis
aseptic (patients with connective-tissue disorders such as
systemic lupus erythematosus may be especially
susceptible).nausea.nephritis tubulointerstitial.
nephropathy.neutropenia.oedema.optic neuritis.oral
ulceration.pancreatitis.paraesthesia.photosensitivity
reaction.platelet aggregation inhibition.renal failure
(more common in patients with pre-existing renal
impairment).respiratory tract reaction.severe cutaneous
adverse reactions (SCARs).skin reactions.stroke.
thrombocytopenia.tinnitus.vertigo.visual impairment.
vomiting
SIDE-EFFECTS, FURTHER INFORMATIONFor information
about cardiovascular and gastrointestinal side-effects, and
a possible exacerbation of symptoms in asthma, see Non-
steroidal anti-inflammatory drugs p. 650.
lALLERGY AND CROSS-SENSITIVITYContra-indicated in
patients with a history of hypersensitivity to aspirin or any
other NSAID—which includes those in whom attacks of
asthma, angioedema, urticaria or rhinitis have been
precipitated by aspirin or any other NSAID.
lPREGNANCYAvoid unless the potential benefit outweighs
the risk. Avoid during the third trimester (risk of closure of
fetal ductus arteriosusin uteroand possibly persistent
pulmonary hypertension of the newborn); onset of labour
may be delayed and duration may be increased.
lBREAST FEEDINGUse with caution during breast-feeding.
Small amount present in milk—manufacturer advises
avoid.
lHEPATIC IMPAIRMENTUse with caution; there is an
increased risk of gastro-intestinal bleeding andfluid
retention. Avoid in severe liver disease.654 Pain and inflammation in musculoskeletal disorders BNFC 2018 – 2019
Musculoskeletal system10