How does it work?
Arcoxia tablets contain the active ingredient etoricoxib, which is a type of medicine known as a non-steroidal anti-inflammatory drug (NSAID).
NSAIDs work by blocking the action of a substance in the body called cyclo-oxygenase. Cyclo-oxygenase is involved in producing prostaglandins, in response to injury or certain diseases. These prostaglandins cause pain, swelling and inflammation. Because NSAIDs block the production of these prostaglandins, they are effective at relieving pain and inflammation.
Cyclo-oxygenase does not only produce prostaglandins that cause inflammation. It also produces prostaglandins that have useful roles in the body. There are two different forms of cyclo-oxygenase, COX-1 and COX-2. COX-2 is the form that (among other things) produces prostaglandins that cause inflammation. COX-1 does not produce inflammatory prostaglandins, but does produce others that have useful effects, including some that are involved in maintaining a healthy stomach and intestinal lining.
Traditional NSAIDs, such as ibuprofen or diclofenac, block the action of both COX-1 and COX-2, and this is why they can sometimes cause side effects such as stomach irritation and peptic ulcers. Etoricoxib belongs to a new generation of NSAIDs that selectively block the action of COX-2. This means that it stops the production of inflammatory prostaglandins, without stopping the production of prostaglandins that protect the stomach and intestines. It therefore reduces pain and inflammation, but is less likely than traditional NSAIDs to cause side effects on the stomach and intestines (although such side effects are still possible).
This medicine can be taken with or without food, but may start to work quicker if taken without food.
What is it used for?
- Acute gout.
- Rheumatoid arthritis.
- This medicine may cause fatigue and dizziness. You should take care when performing potentially hazardous activites, such as driving or operating machinery, until you know how this medicine affects you and are sure you can perform such activities safely.
- NSAIDs can occasionally cause serious side effects on the gut, such as ulceration, bleeding or perforation of the stomach or intestinal lining. This type of side effect is more likely to occur in elderly people and in people taking high doses of the medicine. The risk can also be increased by taking certain other medicines (see below). It is important that these people, as well as people with a history of disorders affecting the stomach or intestines, are closely monitored by a doctor while taking this medicine. All people taking this medicine should stop treatment and consult their doctor immediately if they experience any sign of bleeding from the stomach or intestine during treatment, for example vomiting blood and/or passing black/tarry/bloodstained stools.
- COX-2 inhibitors may carry an increased risk of heart attacks and stroke when compared to placebo (no treatment). If you have risk factors for heart disease or stroke, such as diabetes, high cholesterol or smoking, your doctor will need to assess the overall benefits and risks before deciding if this medicine is suitable for you. In general, if this medicine is suitable, your doctor will prescribe the lowest effective dose for as short a time as possible to control your symptoms, because the risks may increase with higher doses and the longer the medicine is taken. Do not exceed the prescribed dose. Tell your doctor if you experience shortness of breath, chest pains or ankle swelling while taking the medicine. Ask your doctor or pharmacist for further information.
- Your blood pressure should be regularly monitored while you are taking this medicine, particularly in the first two weeks after starting treatment.
- People with impaired kidney, liver or heart function should have their kidney function monitored while taking this medicine.
- During long-term treatment your doctor may want to take regular blood tests to monitor your liver function. Consult your doctor promptly if you develop unexplained itching, yellowing of the skin or eyes, unusually dark urine, nausea and vomiting, abdominal pains, loss of appetite or flu-like symptoms while taking this medicine, as they may be signs of a liver problem.
- This medicine may hide fever, which is a sign of infection. This may make you think mistakenly that an infection is getting better when it isn't, or that an infection is less serious than it is. For this reason you should tell your doctor if you get an infection while you are taking this medicine.
- Very rarely, NSAIDS may cause serious blistering or peeling skin reactions (eg Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis). For this reason, you should stop taking this medicine and consult your doctor if you get a skin rash or sores inside your mouth while taking this medicine. This side effect is very rare, but if it occurs, is most likely to happen in the first month of treatment.
Use with caution in
- Elderly people.
- History of disorders affecting the stomach or intestines, such as ulceration or bleeding.
- Decreased kidney function.
- Decreased liver function.
- Liver cirrhosis.
- History of heart failure.
- Swelling due to excess fluid retention (oedema).
- High blood pressure (hypertension).
- Raised levels of fats such as cholesterol in the blood (hyperlipidaemia).
- History of allergies to medicines.
Not to be used in
- Children and adolescents under 16 years of age.
- People in whom aspirin or other NSAIDs, eg ibuprofen, cause allergic reactions such as asthma attacks, itchy rash (urticaria), nasal polyps, nasal inflammation (rhinitis) or swelling of the lips, tongue and throat (angioedema).
- Severely decreased liver function.
- Moderate to severely decreased kidney function.
- Active peptic ulcer or bleeding from the gut.
- Inflammatory bowel disease such as Crohn's disease or ulcerative colitis.
- Uncontrolled high blood pressure (hypertension).
- Heart failure.
- Heart disease caused by inadequate blood flow to the heart (ischaemic heart disease), eg angina or history of heart attack.
- Disease of the blood vessels in and around the brain (cerebrovascular disease), eg history of stroke.
- Poor circulation in the arteries of the legs or feet (peripheral arterial disease).
- Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malsorption (Arcoxia tablets contain lactose).
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine should not be used in pregnancy, particularly the third trimester, as it may delay labour, increase the length of labour and cause complications in the newborn baby. Some evidence suggests that NSAIDs should also be avoided by women attempting to conceive, as they may temporarily reduce female fertility during treatment and may also increase the risk of miscarriage or malformations. Seek medical advice from your doctor.
- It is not known whether this medicine passes into breast milk. Mothers who need to take this medicine should not breastfeed. Seek medical advice from your doctor.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
Common (affect between 1 in 10 and 1 in 100 people)
- Excessive fluid retention in the body tissues, resulting in swelling (oedema).
- High blood pressure (hypertension).
- Awareness of your heartbeat (palpitations).
- Disturbances of the gut such as diarrhoea, nausea, indigestion, flatulence or abdominal pain.
- Feeling weak or fatigued.
- Cold or flu-like symptoms.
Uncommon (affect between 1 in 100 and 1 in 1000 people)
- Change in appetite, weight gain.
- Anxiety or depression.
- Difficulty sleeping (insomnia).
- Change in taste.
- Changes in sensation, eg pins and needles or tingling sensations.
- Blurred vision.
- Nosebleeds (epistaxis).
- Cough or shortness of breath (dyspnoea).
- Skin reactions such as rash and itch.
- Muscle cramps.
- Chest pain.
- Heart failure, heart attack, stroke or mini-stroke (see warning section above for more information).
Very rare (affect less than 1 in 10,000 people)
- Ulceration or bleeding in the stomach or intestine (see warning section above for more information).
- Liver or kidney disorders.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.
This medicine may be taken with low-dose (75mg daily) aspirin. However, the combination may carry an increased risk of ulceration or bleeding in the stomach or intestines compared to taking etoricoxib on its own. Etoricoxib should not be taken with higher daily doses of aspirin. For more information and advice ask your doctor or pharmacist.
This medicine should not be taken with other non-steroidal anti-inflammatory drugs (NSAIDs), eg ibuprofen, diclofenac, as using more than one NSAID together may also increase the risk of side effects on the gut.
This medicine may increase the anti-blood-clotting effect of warfarin. People taking warfarin or other anticoagulant medicines at the same time as this medicine should therefore have their blood-clotting time (INR) regularly monitored, particularly in the first few days of treatment with etoricoxib and following any dose changes.
This medicine may oppose the effect of diuretics and other medicines for high blood pressure (antihypertensives).
There may be an increased risk of side effects on the kidneys if this medicine is taken with any of the following medicines. People taking any of these medicines in combination with etoricoxib should have their kidney function monitored, particularly if elderly:
- ACE inhibitors, eg enalapril, captopril
- angiotensin II antagonists, eg losartan
This medicine may increase the blood levels of the following medicines:
- lithium (your lithium blood level should be monitored if you are starting, changing dose, or stopping etoricoxib while taking lithium)
- methotrexate (people taking methotrexate should be monitored for any side effects of methotrexate while taking etoricoxib)
- oestrogens in oral contraceptives or HRT (this may increase the risk of side effects from these medicines; discuss this with your doctor)
Rifampicin may decrease the blood level of this medicine and therefore make it less effective at treating pain.
Other medicines containing the same active ingredient
There are currently no other medicines available in the UK that contain etoricoxib as the active ingredient.