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Total Hip in a Day: Setup and Early Experiences in Outpatient Hip Surgery
Published in K. Mohan Iyer, Hip Joint in Adults: Advances and Developments, 2018
In addition to the standard medications, we routinely administer 120 mg Arcoxia (etoricoxib) at 7:00 p.m. and Targin 10/5 at home at about 9:00 p.m. once the patient gets home. Management of antithrombotic therapy consists of Clexane (enoxaparin) injections or Xarelto (rivaroxaban) for 30 days after surgery.
Clinical pharmacology: traditional NSAIDs and selective COX-2 inhibitors
Published in Pamela E Macintyre, Suellen M Walker, David J Rowbotham, Clinical Pain Management, 2008
Stephen F Jones, Aidan M O’Donnell
Etoricoxib has a long half-life (22 hours) and is suitable for once-daily dosing in the treatment of arthritic and musculoskeletal problems. It carries a low risk of gastrointestinal side effects,118 but may be associated with more frequent and severe effects on blood pressure than other COX-2 inhibitors, particularly at high dose.57, 119
Clinical pharmacology and therapeutics: nonopioids
Published in Nigel Sykes, Michael I Bennett, Chun-Su Yuan, Clinical Pain Management, 2008
Rofecoxib carries a dose-related cardiovascular risk.264[III] Despite Merck’s continued insistence that risk only increases after 18 months of use,267, 268, 269 substantial evidence indicates that it is elevated early on.262, 264, 270, 271, 272 Meta-analysis of epidemiological studies,264[III] and of RCTs,273[I] found no increased cardiovascular risk from celecoxib, in contrast to Kearney’s review of RCTs,265[I] which found celecoxib to be as risky as rofecoxib. However, more recent trial and survey results showed an increased risk274, 275[III] especially in the presence of previous myocardial infarction.276, 277 [III] Despite an early negative meta-analysis,278 valdecoxib was withdrawn in 2005 due to severe dermatological reactions, but also after the FDA had expressed disquiet about early toxicity,279 a lack of adequate cardiovascular safety data, and a lack of demonstrated advantages over other NSAIDs. A recent survey ascribed it the highest risk of myocardial infarction,275[III] (rofecoxib surprisingly came out as the lowest risk). Data for etoricoxib are limited but suggest moderate thrombogenicity.280[I] The TARGET study suggests that lumiracoxib carries similar risks to naproxen or ibuprofen, irrespective of aspirin use.281[II] A trade-sponsored metaanalysis confirms low risk,282[I] but powerful data are still scarce.
Merging konjac glucomannan with other copolymeric hydrogels as a cutting-edge liquid raft system for dual delivery of etoricoxib and famotidine
Published in Drug Delivery, 2023
Nabil A. Shoman, Marwa Saady, Mahmoud Teaima, Rehab Abdelmonem, Mohamed A. El-Nabarawi, Sammar Fathy Elhabal
Etoricoxib (ETO) is considered a selective cyclo-oxygenase-2 inhibitor, a sub-class of non-steroidal anti-inflammatory drugs, that obstructs prostaglandin production by inhibiting cyclo-oxygenase enzymes, thus reducing pain, discomfort, and inflammation resulting in an analgesia effect (Ahmadi et al., 2022; Farag & Bahra, 2022; Ju et al., 2022). Multiple clinical trials have demonstrated the clinical efficacy of ETO in treating acute and chronic pain associated with different diseases like acute gout, dysmenorrhea, oral surgery, rheumatoid arthritis, osteoarthritis, and chronic lower back pain (la Torre et al., 2021). The assessment of its side effects showed some cardiovascular risks, different renal events, dizziness, headache, and GIT disturbances like nausea, vomiting, and peptic ulcer (Kirschneck et al., 2019; la Torre et al., 2021). Although it exhibits some GIT problems and peptic ulcers, evidence-based studies showed that these effects are well tolerated and less likely to happen in contrast to ibuprofen or nonselective NSAIDs (Martina et al., 2005; Yuan & Hunt, 2007).
Safety of treatment options available for postoperative pain
Published in Expert Opinion on Drug Safety, 2021
Zhaosheng Jin, Christopher Lee, Kalissa Zhang, Tong J Gan, Sergio D Bergese
Dahl et al. conducted a systematic review with meta-analysis of NSAIDS in the postoperative period of 10 clinical trials and determined that nonselective NSAIDs have a consistent and significant opioid-sparing effect in the post-operative period with reduction in opioid-related adverse effects particularly post-operative nausea, vomiting and sedation; this is in contrast to COX-2 antagonists, where the opioid-sparing effect has not been associated with reduction in opioid-related adverse effects [31]. However, COX-2 inhibitors have been shown to provide effective analgesia compared to placebo as seen in Lloyd et al. who performed a Cochrane review that determined parecoxib for acute postoperative pain in adults provided significant analgesia compared to placebo with fewer participants requiring a rescue dose of medication in higher doses [32]. Furthermore, Clark et al. conducted a Cochrane review on the effects of COX-2 inhibitor, etoricoxib, and determined that single dose oral etoricoxib is as effective or better than other commonly used analgesics [33].
A review of dexketoprofen trometamol in acute pain
Published in Current Medical Research and Opinion, 2019
Secondary efficacy outcome measures evaluated in the various meta-analyses related to the use of rescue analgesia. Risk ratios versus placebo for the proportion of patients requiring rescue medication 6 hours after taking the study medication were 0.66 (95% CI 0.56–0.78) for dexketoprofen trometamol 25 (or 20) mg and 0.24 (95% CI 0.17–0.34) for etoricoxib 120 mg (Table 2); data was not reported for celecoxib. However, whereas the dosing interval for dexketoprofen trometamol is every 4–8 hours, etoricoxib is administered once daily and celecoxib once or twice daily. When evaluated over the expected duration of action (24 hours), the risk ratio for use of rescue medication with etoricoxib 120 mg was 0.46 (95% CI 0.38–0.56), and that for celecoxib 400 mg was 0.68 (95% CI 0.62–0.74), both closer to the value of 0.66 (95% CI 0.56–0.78) seen for dexketoprofen trometamol during its expected period of action of 6 hours. The median time to use of rescue medication reflected the expected duration of action of the drugs, ranging from 4.7 hours with dexketoprofen trometamol 25 mg to 8.4 hours with celecoxib 400 mg and >24 hours for etoricoxib 120 mg (Table 3).