Sulfasalazine
Contraindicated
Textbook
Exacerbation of inflammatory bowel disease (IBD).
Avoid combining sulfasalazine with traditional NSAIDs.
Source: G&G 14e · p1112
Drug reference
Etoricoxib
NSAID (selective COX-2 inhibitor / coxib) · Analgesic
Also known as Arcoxia, Nucoxia, Etoshine, Etomark, Brutaflam Etoricoxib
START
Start at lowest effective dose (30 mg for OA); check BP and renal function baseline
TYPICAL MAX
90 mg/day chronic; 120 mg/day acute gout (max 8 days)
STOP IF
GI bleed, CV event, BP >160/100, severe edema, eGFR <30, rash
WATCH
BP at each visit, renal function, GI symptoms, cardiovascular risk
CDSCO approvedSchedule HATC M01AH05
KDIGO 2024 + manufacturer label
- ONSET
- 24min · Rapid analgesic onset
- PEAK
- 1h · Peak plasma concentration
- t½
- 22h · Elimination half-life
- DURATION
- 1d · Once-daily dosing covers 24h
EXCRETION
Fecal (~70%) and renal (~20%)
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Contraindicated in pregnancy; risk of fetal cardiovascular malformations and premature ductus arteriosus closure
FDA category + note
Top interactionssee all 12 →
- SulfasalazineContraindicatedTextbookG&G 14e · p1112
- AminoglycosideSevereTextbookKDT 7e · p746
- AminoglycosidesSevereTextbookKDT 7e
- AnticoagulantsSevereTextbookKDT 7e
Available in India
1,145 branded formulations and 817 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Mechanism
Selective inhibition of cyclo-oxygenase-2 (COX-2), sparing COX-1-mediated gastric mucosal protection at therapeutic doses
Indications
OsteoarthritisRheumatoid arthritisAnkylosing spondylitisAcute goutChronic low back pain
Dosing
- Adult
- OA: 30 mg OD; RA/AS: 90 mg OD; Acute gout: 120 mg OD (max 8 days); CLBP: 60 mg OD
- Pediatric
- Not recommended under 16 years
- Renal adjustment
- Contraindicated if eGFR <30; not recommended 30-60 without close monitoring
- Hepatic adjustment
- Contraindicated in severe hepatic impairment; max 30 mg in mild-moderate
- Geriatric
- No dose adjustment needed based on age alone; monitor renal function and BP
- Max dose
- 120 mg/day (acute gout, limited to 8 days); 90 mg/day (chronic indications)
Pharmacokinetics
Onset
24 minutes (analgesic onset)
Peak effect
1 hour (Tmax)
Duration
24 hours
Half-life
22 hours
Bioavailability
100%
Protein binding
92%
Metabolism
Hepatic CYP3A4 (major) and CYP2C9 (minor); 6'-methyl hydroxylation is primary pathway
Excretion
Fecal (~70% as metabolites); renal (~20%)
Contraindications
- Active peptic ulcer or GI bleeding
- History of GI perforation/ulcer/bleeding with NSAIDs
- Severe congestive heart failure (NYHA III-IV)
- Uncontrolled hypertension (BP >140/90 mmHg)
- Ischemic heart disease, cerebrovascular disease, peripheral arterial disease
- Severe hepatic impairment
- Pregnancy and lactation
- Hypersensitivity to etoricoxib or sulfonamides
Side effects
Common
HeadacheDizzinessPeripheral edemaHypertensionDyspepsiaNauseaDiarrheaFatigueInfluenza-like illness
Serious
- Cardiovascular thrombotic events (MI, stroke)
- GI bleeding/ulceration/perforation
- Severe hepatic reactions
- Stevens-Johnson syndrome / TEN
- Anaphylaxis
- Acute renal failure
- Congestive heart failure
Pregnancy & lactation
Pregnancy
Contraindicated in pregnancy; risk of fetal cardiovascular malformations and premature ductus arteriosus closure
Lactation
Excretion in breast milk unknown; contraindicated during breastfeeding
Drug interactions
Aminoglycoside
Severe
Textbook
Increased risk of nephrotoxicity.
Avoid concurrent use.
Source: KDT 7e · p746
Aminoglycosides
Severe
Textbook
Increased aminoglycoside levels and potential toxicity.
Monitor aminoglycoside levels and renal function; adjust dosage as needed.
Source: KDT 7e
Anticoagulants
Severe
Textbook
Increased risk of gastrointestinal bleed.
Monitor for bleeding; consider alternative analgesics or gastroprotective agents.
Source: KDT 7e
Ciprofloxacin
Severe
Textbook
Enhanced CNS toxicity, seizures reported.
Source: KDT 7e
Citalopram
Severe
Textbook
Increased risk of gastrointestinal bleed.
Monitor for bleeding; consider gastroprotective agents or alternative analgesics.
Source: KDT 7e
Clopidogrel
Severe
Textbook
Increased bleeding risk.
Exercise extra caution and monitor for signs of bleeding.
Source: G&G 14e
Corticosteroids
Severe
Textbook
Increased risk of gastrointestinal bleed.
Monitor for bleeding; consider gastroprotective agents.
Source: KDT 7e
Dapoxetine
Severe
Textbook
Increased risk of gastrointestinal bleed.
Monitor for bleeding; consider gastroprotective agents or alternative analgesics.
Source: KDT 7e
Enalaprilat
Severe
Textbook
Reduced effectiveness of ACE inhibitors. Marked hyperkalemia, potentially leading to cardiac arrhythmia.
Use with caution, especially in the elderly and in patients with hypertension, diabetes mellitus, or ischemic heart disease.
Source: G&G 14e · p836
Escitalopram + Clonazepam
Severe
Textbook
Increased risk of gastrointestinal bleed.
Monitor for bleeding; consider gastroprotective agents or alternative analgesics.
Source: KDT 7e
Escitalopram
Severe
Textbook
Increased risk of gastrointestinal bleed.
Monitor for bleeding; consider gastroprotective agents or alternative analgesics.
Source: KDT 7e
Related guidelines
Ask House about Etoricoxib
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19