Etoricoxib: -Class -Concerns/Risks -General prescribing points -Renal -MHRA Guidance

-COX-2 Inhibitors -There are general GI & Renal concerns & increased risk of CV events -Use safest NSAID with lowest effective dose for shortest amount of time -Naproxen (1,000 mg daily or less) and low-dose ibuprofen (1,200 mg daily or less) have the most favourable cardiovascular safety profiles of all NSAIDs -Discuss any risks and how to mitigate them (e.g. prescribe PPI if necessary) -Drugs that inc risk of AKI are a double whammy (NSAID + ACEi) or triple whammy (NSAID + ACEi + diuretic) -NSAIDs can cause renal failure -Risk factors: existing renal impairment, elderly, people with diseases or taking drugs that predisposes them to renal failure -MHRA warning about Etoricoxib and its CV risks which increase with dose & duration- lowest effective daily dose should be used -Etoricoxib should not be Rx to those with BP presistently above 140/90 mmHg & inadequately controlled - BP needs to be controlled (as it increases CV risk)- before treatment