MTW NHS Trust West Kent CCG

Drug Status Key

  • Preferred
  • Second Line
  • Third Line
  • Specialist Initiation
  • Hospital Only
  • Not Approved for Formulary

Cox-2 inhibitors

Drug Safety Update

 December 2014: Etoricoxib: prescribing to patients with high blood pressure

 October 2016: Etoricoxib (Arcoxia): revised dose recommendation for rheumatoid arthritis and ankylosing spondylitis

 December 2014: NSAIDs and coxibs: balancing of cardiovascular and gastrointestinal risks

 December2014: Non-steroidal anti-inflammatory drugs (NSAIDs): reminder on renal failure and impairment

NICE guidance

CG177: Osteoarthritis: care and management, updated December 2020

Cardiovascular risk: COX-2s cause a small increased risk of thrombotic events, (e.g. myocardial infarction and stroke), compared with placebo and the risk may increase with dose and duration of exposure. Patients with established ischaemic heart disease or cerebovascular disease should not take COX-2 inhibitors.

Aspirin: the addition of a COX-2 inhibitor to low-dose aspirin increases ulcer incidence to a rate similar to NSAIDs alone. It is advised to avoid co-prescribing with low-dose aspirin as there is no benefit in terms of gastrointestinal safety.

Indications: COX-2s should be used only when specifically indicated, (i.e. for patients who are at a particularly high risk of developing gastroduodenal ulcer, perforation or bleeding) and after an assessment of cardiovascular risk. The lowest effective dose of COX-2 inhibitor should be used for the shortest necessary period.

Celecoxib is licensed for pain and inflammation in osteoarthritis or rheumatoid arthritis only and not for acute pain. Monitor blood pressure before and during treatment.

Etoricoxib is licensed for the relief of pain associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and gout. It is available as an alternative to celecoxib. For gout, the recommended dose is 120mg daily; this may be used in the acute phase for up to 8 days. Monitor blood pressure before and during treatment.

Pack Price
60 capsule (6 x 10 capsules) £4.08
Pack Price
30 capsule (3 x 10 capsules) £3.80
Pack Price
28 tablet £4.37
Pack Price
28 tablet £19.80
Pack Price
28 tablet £23.22
Pack Price
28 tablet £17.11
7 tablet