Coxiron Drug Interactions

Warfarin: In patients stabilized on chronic warfarin therapy, the administration of etoricoxib 120 mg daily was associated with an increase in prothrombin time international normalized ratio (INR). Standard monitoring of INR values should be conducted when therapy with etoricoxib is initiated or changed, particularly in the first few days, in patients receiving warfarin or similar agents.
Rifampin: Coadministration of etoricoxib with rifampin, a potent inducer of hepatic metabolism, decreased in etoricoxib plasma area under the curve (AUC). This interaction should be considered when etoricoxib is coadministered with rifampin.
Methotrexate: Etoricoxib 120 mg increased methotrexate plasma concentrations and reduced renal clearance of methotrexate. Monitoring for methotrexate-related toxicity should be considered when etoricoxib at doses greater than 90 mg daily and methotrexate are administered concomitantly.
Diuretics, angiotensin converting enzyme (ACE) Inhibitors and angiotensin II antagonists (AIIAs): Reports suggest that NSAIDs including selective COX-2 inhibitors may diminish the antihypertensive effect of diuretics, ACE inhibitors and AIIAs. This interaction should be given consideration in patients taking etoricoxib concomitantly with these products.
Lithium: Reports suggest that non-selective NSAIDs and selective COX-2 inhibitors may increase plasma lithium levels. This interaction should be given consideration in patients taking etoricoxib concomitantly with lithium.
Aspirin: Etoricoxib can be used concomitantly with low-dose aspirin at doses for cardiovascular prophylaxis. However, concomitant administration of low-dose aspirin with etoricoxib results in an increased rate of GI ulceration or other complications compared to use of etoricoxib alone. At steady-state, etoricoxib 120 mg once daily had no effect on the anti-platelet activity of low dose aspirin (81 mg once daily) (see Warnings and Precautions).
Oral contraceptives: Etoricoxib 60 mg given concomitantly with an oral contraceptive ethinyl estradiol (EE) and norethindrone increased the steady-state AUC_{0-24 hr} of EE. Etoricoxib 120 mg given with the same oral contraceptive, either concomitantly or separated by 12 hours, increased the steady-state AUC_{0-24 hr} of EE. This increase in EE concentration should be considered when selecting an appropriate oral contraceptive for use with etoricoxib. An increase in EE exposure can increase the incidence of adverse events associated with oral contraceptives (e.g., venous thrombo-embolic events in women at risk).
Hormone replacement therapy: Administration of etoricoxib 120 mg with hormone replacement therapy consisting of conjugated estrogens increased the mean steady-state AUC_0-24hr of unconjugated estrone, equilin and 17-β-estradiol. The effect of the recommended chronic doses of etoricoxib has not been studied. These increases in estrogenic concentration should be taken into consideration when selecting postmenopausal hormone therapy for use with etoricoxib.
Other: In drug-interaction studies, etoricoxib did not have clinically important effects on the pharmacokinetics of prednisone/prednisolone or digoxin. Antacids and ketoconazole (a potent inhibitor of CYP3A4) did not have clinically important effects on the pharmacokinetics of etoricoxib.