Hofxib 90 Special Precautions

Etoricoxib increases risk of serious adverse cardiovascular thrombotic events, including MI and stroke. Risk may be increased with long term use or pre-existing cardiac risk factors (eg. hypertension, hyperlipidemia, diabetes, smoking). Carefully evaluate individual cardiovascular profiles prior to prescribing and periodically reevaluate the need for symptomatic relief and response to therapy.
Discontinue use of etoricoxib if worsening heart failure, edema or uncontrolled/severe hypertension occur. Use the lowest effective dose for shortest duration of time, consistent with individual patient goals, to reduce risk of cardiovascular events; consider alternative therapies for high-risk patients.
Should be aware to use etoricoxib in patients who may develop serious upper GI complications including perforations, ulcers and bleeding have occurred, concurrent therapy with aspirin or other NSAIDs, anticoagulants, and/or corticosteroids, smoking, alcohol, elderly and debilitated patients.
Gastroprotective therapy (eg. proton pump inhibitors, misoprostol) is recommended when etoricoxib is used concomitantly with aspirin (even at low dose).
Etoricoxib does not usually affect Prothrombin time (PTT) or platelet counts; does not inhibit aggregation at approved dose.
Elevations in transaminases (>3 times the upper limit of normal) may occur; monitor hepatic function closely in patients with previous abnormal hepatic function tests or sign & symptoms of hepatic function.
Etoricoxib may increase the risk of hyperkalemia, particularly in diabetics and with concomitant use of other agents capable of inducing hyperkalemia. Monitor potassium closely.
Discontinue use of etoricoxib at first appearance of skin rash, mucosal lesions or any other sign of hypersensitivity.
Do not administer etoricoxib to patients with aspirin-sensitive asthma, severe bronchospasm. Use with caution in patients with other forms of asthma.
Risk of MI and stroke may be increased with the use of etoricoxib following coronary artery bypass graft (CABG) surgery. Etoricoxib is not recommended for treatment of perioperative pain in the setting of CABG.
Use etoricoxib with caution in mild to moderate renal impairment. Monitor renal function closely, discontinue use with persistent or worsening renal dysfunction.