Coxiron Warnings

Cardiovascular risk: NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Elderly patients and patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk (see as follows and Precautions).
Etoricoxib is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery (see as follows and Precautions).
Gastrointestinal risk: NSAIDs cause an increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events (see as follows and Precautions).
Asthma and skin reaction: Etoricoxib is contraindicated to patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs (see as follows and Precautions).
Congestive heart failure and edema: Etoricoxib should be used with caution in patients with fluid retention or heart failure (see as follows and Precautions).
Hepatic effects: Patients with symptoms and/or signs suggesting liver dysfunction, or in whom an abnormal liver test has occurred, should be evaluated for evidence of the development of a more severe hepatic reaction while on therapy with etoricoxib (see as follows and Precautions).
Renal effects: Long-term administration of NSAIDs, has resulted in renal papillary necrosis and other renal injury. Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion (see as follows and Precautions).
Cardiovascular thrombotic effects: Several COX-2 and nonselective NSAIDs have shown an increased risk of serious cardiovascular (CV) thrombotic events, myocardial infarction, and stroke, which can be fatal. All NSAIDs both COX-2 selective and nonselective, may have a similar risk. Patients with known CV disease or risk factors for CV disease may be at greater risk. To minimize the potential risk for an adverse CV event in patients treated with a NSAID, the lowest effective dose should be used for the shortest duration possible. Physicians and patients should remain alert for the development of such events, even in the absence of previous CV symptoms. Patients should be informed about the signs and/or symptoms of serious CV events and the steps to take if they occur.
There is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious CV thrombotic events associated with NSAIDs use. The concurrent use of aspirin and NSAIDs does increase the risk of serious GI events (see Gastrointestinal effects as follows).
The use of COX-2 selective NSAIDs for the treatment of pain in the first 10-14 days following CABG surgery found an increased incidence of myocardial infarction and stroke (see Contraindications).
Hypertension: NSAIDs, including etoricoxib, can lead to onset of new hypertension or worsening of pre-existing hypertension, either of which may contribute to the increased incidence of CV events. Patients taking thiazides or loop diuretics may have impaired response to these therapies when taking NSAIDs. NSAIDs, including etoricoxib, should be used with caution in patients with hypertension. Blood pressure (BP) should be monitored closely during the initiation of NSAIDs treatment and throughout the course of therapy.
Congestive heart failure: Fluid retention and edema have been observed in some patients taking NSAIDs. Etoricoxib should be used with caution in patients with fluid retention or heart failure.
Gastrointestinal effects - risk of ulceration, bleeding, and perforation: NSAIDs, including etoricoxib, can cause serious gastrointestinal (GI) adverse events including inflammation, bleeding, ulceration, and perforation of the stomach, small intestine, or large intestine, which can be fatal. These serious adverse events can occur at any time, with or without warning symptoms, in patients treated with NSAIDs. Upper GI ulcers, gross bleeding or perforation caused by NSAIDs occur in approximately 1% of patients treated for 3-6 months, and in about 2-4% of patients treated for 1 year. These trends continue with longer duration of use, increasing the likelihood of developing a serious GI event at some time during the course of therapy. However, even short-term therapy is not without risk.
NSAIDs should be prescribed with extreme caution in those with a prior history of ulcer disease or gastrointestinal bleeding. Patients with a prior history of peptic ulcer disease and/or gastrointestinal bleeding who use NSAIDs have a greater than 10-fold increased risk for developing a GI bleed compared to patients with neither of these risk factors. Other factors that increase the risk for GI bleeding in patients treated with NSAIDs include concomitant use of oral corticosteroids or anticoagulants, longer duration of NSAIDs therapy, smoking, use of alcohol, older age, and poor general health status. Most spontaneous reports of fatal GI events are in elderly or debilitated patients and therefore, special care should be taken in treating in this population.
To reduce the risk of gastrointestinal effect on NSAIDs therapy, the lowest effective dose must be given and short-term therapy. Doctor and patient must be caution on sign and symptoms of ulceration and gastrointestinal bleeding during NSAIDs therapy. If there is serious gastrointestinal effects suspected, evaluate immediately and give additional treatment. For high risk patient, alternative therapy that does not include NSAlDs can be considered.