Torixib Drug Interactions

Warfarin: Coadministration of an anticoagulant and an NSAID may increase the risk of serious bleeding. Patients receiving oral anticoagulants should be closely monitored for their prothrombin time INR, particularly in the first few days when therapy with Etoricoxib is initiated or the dose of Etoricoxib is changed.
Rifampin: Concurrent administration of Etoricoxib, a CYP3A4 substrate, and rifampin, a potent CYP3A4 inducer, results in a 65% reduction on Etoricoxib blood concentrations. This increase in Etoricoxib metabolism may lead to symptom recurrence when Etoricoxib and rifampin are co-administered.
Methotrexate: The concomitant use of Etoricoxib and methotrexate may cause increased methotrexate plasma concentrations. Monitor for methotrexate toxicity during therapy if Etoricoxib and methotrexate coadministration is necessary.
Diuretics, Angiotensin Converting Enzyme (ACE) Inhibitors and Angiotensin II Antagonists (AIIAs): 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. 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 NSAIDs, 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: NSAIDs, including selective COX-2 inhibitors decrease lithium renal excretion and therefore increase lithium plasma levels. This interaction should be given consideration in patients taking Etoricoxib with lithium. Monitor serum lithium levels frequently and observe for sign and symptoms of lithium toxicity.
Aspirin: Etoricoxib can be used concomitantly with aspirin at doses used for cardiovascular prophylaxis (low-dose aspirin). However, concomitant administration of low-dose aspirin with Etoricoxib may result in an increased rate of GI ulceration or other complications compared to use of Etoricoxib alone. Concomitant administration of Etoricoxib with doses of aspirin above those for cardiovascular prophylaxis or with other NSAIDs is not recommended.
Cyclosporin and tacrolimus: Coadministration of cyclosporin or tacrolimus with any NSAID may increase the nephrotoxic effect of cyclosporin or tacrolimus. Renal function should be monitored when Etoricoxib and either of these drugs is used in combination.
Oral contraceptives: The increase in ethinyl estradiol concentration should be considered when selecting an oral contraceptive for use with Etoricoxib. An increase in ethinyl estradiol 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: The increases in estrogenic concentration should be taken into consideration when selecting post-menopausal hormone therapy for use with Etoricoxib because the increase in estrogen exposure might increase the risk of adverse events associated with HRT.
Digoxin: Coadministration of digoxin and NSAIDs may increase digoxin plasma concentrations and prolong the half-life of digoxin. Patients at high risk of digoxin toxicity should be monitored when Etoricoxib and digoxin are administered concomitantly.
Effect of Etoricoxib on drugs metabolized by sulfotransferases: Etoricoxib inhibits human sulfotransferase activity (particularly that of SULT1E1 substrates) and increases serum ethinyl estradiol, a human sulfotransferase substrate. Therefore, coadministration of Etoricoxib and drugs primarily metabolized by human sulfotransferases (e.g. oral salbutamol and minoxidil) may also increase the exposure of these drugs. Use caution if concurrently administration is required.
Prednisone/prednisolone: Etoricoxib do not have clinically important effects on the pharmacokinetics of prednisone/prednisolone.
Ketoconazole: Ketoconazole do not have clinically important effects on the pharmacokinetics of Etoricoxib.
Antacids: Antacids do not have clinically important effects on the pharmacokinetics of Etoricoxib.