Meicoxia Drug Interactions

Warfarin: Standard monitoring of International Normalized Ratio (INR) values should be conducted when therapy with Meicoxia is initiated or changed, particularly in the first few days, in patients receiving warfarin or similar agent.
Rifampin: Co-administration of Meicoxia with rifampin, a potent inducer of hepatic metabolism, produced a 65% decreased in etoricoxib plasma area under the curve (AUC). This interaction should be considered when Meicoxia is co-administered with rifampin.
Methotrexate: Monitoring for methrotrexate-related toxicity should be considered when Meicoxia at dose greater than 90 mg daily and methrotrexate 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 Meicoxia concomitantly with these products.
In some patients with compromised renal function (e.g., elderly patients or patients who are volume-depleted, including those on diuretic therapy) who are being treated with non-steroidal anti-inflammatory drugs, including selective COX-2 inhibitors, the co-administration of ACE inhibitors or AIIAs may result in a further deterioration of renal function, including possible acute renal failure. These effects are usually reversible. Therefore, the combination should be administered with caution, especially in the elderly. Patients should be adequately hydrated and consideration should be given to monitoring of renal function after initiation of concomitant therapy, and periodically thereafter.
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 Meicoxia concomitantly with lithium.
Aspirin: Meicoxia can be used concomitantly with low-doses for cardiovascular prophylaxis. At steady state, etoricoxib 120 mg once daily had no effect on the anti-platelet activity of low-dose aspirin (81 mg once daily). However, concomitant administration of low-dose aspirin with Meicoxia increases the rate of GI ulceration or other complication compared to use of Meicoxia alone. Concomitant administration of etoricoxib with doses of aspirin above those for cardiovascular prophylaxis or with other NSAIDs is not recommended.
Cyclosporin and tacrolimus: co-administration of cyclosporine or tacrolimus with any NSAID may increase the nephrotoxic effect of cyclosporine or tacrolimus. Renal function should be monitored when etoricoxib and either of these drugs are used in combination.
Oral Contraceptives: Etoricoxib 60 mg and 120 mg given concomitantly with an oral contraceptive increased the steady state AUC_0-24hr of EE by 37% and 50-60% respectively. The increase in EE concentration should be considered when selecting an oral contraceptive for use with etoricoxib. An increase in Ethinyl estradiol (EE) exposure can increase the incidence of adverse events associated with oral contraceptives (e.g., venous thrombo-embolic events in woman at risk).
Hormone Replacement Therapy: Administration of etoricoxib 120 mg with hormone replacement therapy consisting of conjugated estrogens (0.625 mg PREMARIN), increased the mean steady state AUC_{0-24 hr} of unconjugated estrone (41%), equilin (76%) and 17ß-estradiol (22%). These increases in estrogenic concentration should be taken into consideration when selecting post-menopausal hormone therapy for use with Meicoxia because the increase in estrogen exposure might increase the risk of adverse events associated with HRT.
Prednisone/prednisolone: In drug-interaction studies, etoricoxib did not have clinically important effects on the pharmacokinetics of prednisone/prednisolone.
Digoxin: Patients at high risk of digoxin toxicity should be monitored for this when etoricoxib and digoxin are administered concomitantly.
Effect of etoricoxib on drugs metabolized by sulfotransferases: Etoricoxib is an inhibitor of human sulfotransferase activity, particularly SLUT1E1 and has been shown to increase the serum concentrations of ethinyl estradiol. It may be prudent to exercise care when administering etoricoxib concurrently with other drugs primarily metabolized by human sulfotransferases (e.g., oral salbutamol and minoxidil).
Ketoconazole: Ketoconazole, a potent inhibitor of CYP3A4. Dosed at 400 mg once a day for 11 days to healthy volunteers did not have any clinically important effect on the single-dose pharmacokinetics of 60 mg etoricoxib (43% increase in AUC).