ETORICOXIB 90 MG FILM-COATED TABLETS - patient leaflet, side effects, dosage

1. what etoricoxib is and what it is used for

The name of your medicine is Etoricoxib film-coated tablets (referred to as etoricoxib throughout this leaflet). The active substance etoricoxib belongs to a group of medicines called selective COX-2 inhibitors. These belong to a family of medicines called non-steroidal anti-inflammatory drugs (NSAIDs).

Etoricoxib helps to reduce the pain and swelling (inflammation) in the joints and muscles of people 16 years of age and older with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and gout.

Etoricoxib is also used for the short term treatment of moderate pain after dental surgery in people 16 years of age and older.

What is osteoarthritis?

Osteoarthritis is a disease of the joints. It results from the gradual breakdown of cartilage that cushions the ends of the bones. This causes swelling (inflammation), pain, tenderness, stiffness and disability.

What is rheumatoid arthritis?

Rheumatoid arthritis is a long term inflammatory disease of the joints. It causes pain, stiffness, swelling, and increasing loss of movement in the joints it affects. It may also cause inflammation in other areas of the body.

What is gout?

Gout is a disease of sudden, recurring attacks of very painful inflammation and redness in the joints. It is caused by deposits of mineral crystals in the joint.

What is ankylosing spondylitis?

Ankylosing spondylitis is an inflammatory disease of the spine and large joints.

2. what you need to know before you take etoricoxib do not take etoricoxib:

• – if you are allergic to etoricoxib or any of the other ingredients of this medicine (listed in section 6).

• – if you are allergic to non-steroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid and COX-2 inhibitors (see Possible Side Effects, section 4).

• – if you have a current stomach ulcer or bleeding in your stomach or intestines.

• – if you have serious liver disease.

• – if you have serious kidney disease.

• – if you are or could be pregnant or are breast-feeding (see ‚Pregnancy, breast-feeding and fertility‘).

• – if you are under 16 years of age.

• – if you have inflammatory bowel disease, such as Crohn's Disease, ulcerative colitis, or colitis.

• – if you have high blood pressure that has not been controlled by treatment (check with your doctor or nurse if you are not sure whether your blood pressure is adequately controlled).

• – if your doctor has diagnosed you with heart problems including heart failure (moderate or severe types), angina (chest pain).

• – if you have had a heart attack, bypass surgery, peripheral arterial disease (poor circulation in legs or feet due to narrow or blocked arteries).

• – if you have had any kind of stroke (including mini-stroke, transient ischaemic attack or TIA). Etoricoxib may slightly increase your risk of heart attack and stroke and this is why it should not be used in those who have already had heart problems or stroke.

If you think any of these are relevant to you, do not take the tablets until you have consulted your doctor.

Warnings and precautions

Talk to your doctor or pharmacist before taking etoricoxib if: – you have a history of stomach bleeding or ulcers.

• – you are dehydrated, for example by a prolonged bout of vomiting or diarrhoea.

• – you have swelling due to fluid retention.

• – you have a history of heart failure, or any other form of heart disease.

• – you have a history of high blood pressure. Etoricoxib can increase blood pressure in some people, especially in high doses, and your doctor will want to check your blood pressure from time to time.

• – you have any history of liver or kidney disease.

• – you are being treated for an infection. Etoricoxib can mask or hide a fever, which is a sign of infection.

• – you have diabetes, high cholesterol, or are a smoker. These can increase your risk of heart disease.

• – you are a woman trying to become pregnant.

• – you are over 65 years of age.

If you are not sure if any of the above apply to you, talk to your doctor before taking etoricoxib to see if this medicine is suitable for you.

Etoricoxib works equally well in older and younger adult patients. If you are over 65 years of age, your doctor will want to appropriately keep a check on you. No dosage adjustment is necessary for patients over 65 years of age.

Children and adolescents

Do not give this medicine to children and adolescents under 16 years of age.

Other medicines and etoricoxib

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

In particular if you are taking any of the following medicines, your doctor may want to monitor you to check that your medicines are working properly, once you start taking Etoricoxib:

• – medicines that thin your blood (anticoagulants), such as warfarin

• – rifampicin (an antibiotic)

• – methotrexate (a drug used for suppressing the immune system, and often used in rheumatoid arthritis)

• – ciclosporin or tacrolimus (drugs used for suppressing the immune system)

• – lithium (a medicine used to treat some types of depression)

• – medicines used to help control high blood pressure and heart failure called ACE inhibitors and angiotensin receptor blockers, examples include enalapril and ramipril, and losartan and valsartan

• – diuretics (water tablets)

• – digoxin (a medicine for heart failure and irregular heart rhythm)

• – minoxidil (a drug used to treat high blood pressure)

• – salbutamol tablets or oral solution (a medicine for asthma) – birth control pills (the combination may increase your risk of side effects)

• – hormone replacement therapy (the combination may increase your risk of side effects)

• – acetylsalicylic acid, the risk of stomach ulcers is greater if you take etoricoxib with acetylsalicylic a­cid.

• – acetylsalicylic acid for prevention of heart attacks or stroke:

Etoricoxib can be taken with low-dose acetylsalicylic acid. If you are currently taking low-dose acetylsalicylic acid to prevent heart attacks or stroke, you should not stop taking acetylsalicylic acid until you talk to your doctor

• – acetylsalicylic acid and other non-steroidal antiinflammatory drugs (NSAIDs):

do not take high dose acetylsalicylic acid or other antiinflammatory medicines while taking etoricoxib.

Etoricoxib with food and drink

The onset of the effect of etoricoxib may be faster when taken without food.

Pregnancy, breast-feeding and fertility

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Pregnancy

Etoricoxib must not be taken during pregnancy. If you are pregnant or think you may be pregnant or are planning to have a baby, do not take the tablets. If you become pregnant, stop taking the tablets and consult your doctor. Consult your doctor if you are unsure or need more advice.

Breast-feeding

It is not known if etoricoxib is excreted in human milk. If you are breast-feeding, or planning to breast-feed, consult your doctor before taking etoricoxib. If you are taking etoricoxib, you must not breast-feed.

Fertility

Etoricoxib is not recommended in women attempting to become pregnant.

Driving and using machines

Dizziness and sleepiness have been reported in some patients taking etoricoxib.

Do not drive if you experience dizziness or sleepiness. Do not use any tools or machines if you experience dizziness or sleepiness.

3. how to take etoricoxib

Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.

Do not take more than the recommended dose for your condition. Your doctor will want to discuss your treatment from time to time. It is important that you use the lowest dose that controls your pain and you should not take etoricoxib for longer than necessary. This is because the risk of heart attacks and strokes might increase after prolonged treatment, especially with high doses.

There are different strengths available for this medicinal product and depending on your disease your doctor will prescribe the tablet strength that is appropriate for you.

The recommended dose is:

Osteoarthritis

The recommended dose is 30 mg once a day, increased to a maximum of 60 mg once a day if needed.

Rheumatoid arthritis

The recommended dose is 60 mg once a day, increased to a maximum of 90 mg once a day if needed.

Ankylosing spondylitis

The recommended dose is 60 mg once a day, increased to a maximum of 90 mg once a day if needed.

Acute pain conditions

Etoricoxib should be used only for the acute painful period.

Gout

The recommended dose is 120 mg once a day which should only be used for the acute painful period, limited to a maximum of 8 days treatment.

Postoperative dental surgery pain

The recommended dose is 90 mg once daily, limited to a maximum of 3 days treatment.

People with liver problems

If you have mild liver disease, you should not take more than 60 mg a day.

If you have moderate liver disease, you should not take more than 30 mg a day.

Use in children and adolescents

Etoricoxib should not be taken by children or adolescents under 16 years of age.

Elderly

No dose adjustment is necessary for elderly patients. Caution should be exercised in elderly patients.

Method of administration

Etoricoxib is for oral use. Take the tablets once a day. Etoricoxib can be taken with or without food.

If you take more etoricoxib than you should

You should never take more tablets than the doctor recommends. If you do take too many etoricoxib tablets, you should seek medical attention immediately.

If you forget to take etoricoxib

It is important to take etoricoxib as your doctor has prescribed. If you miss a dose, just resume your usual schedule the following day. Do not take a double dose to make up for a forgotten tablet.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

If you develop any of these signs you should stop etoricoxib and talk to your doctor immediately (see

What you need to know before you take etoricoxib section 2):

• – shortness of breath, chest pain, or ankle swelling appear or if they get worse,

• – yellowing of the skin and eyes (jaundice) – these are signs of liver problems,

• – severe or continual stomach pain or your stools become black,

• – an allergic reaction- which can include skin problems such as ulcers or blistering, or swelling of the face, lips, tongue, or throat which may cause difficulty in breathing.

The following side effects can occur during treatment with etoricoxib:

Very common (may affect more than 1 in 10 people)

• – stomach pain.

Common (may affect up to 1 in 10 people)

• – dry socket (inflammation and pain after a tooth extraction),

• – swelling of the legs and/or feet due to fluid retention (oedema),

• – dizziness, headache,

• – palpitations (fast or irregular heartbeat), irregular heart rhythm (arrhythmia),

• – increased blood pressure,

• – wheezing or shortness of breath (bronchospasms),

– constipation, wind (excessive gas), gastritis (inflammation of the lining of the stomach), heartburn, diarrhoea, indigestion (dyspepsia)/stomach discomfort, nausea, being sick (vomiting), inflammation of the oesophagus, mouth ulcers,

– changes in blood tests related to your liver,

– bruising,

– weakness and fatigue, flu-like illness.

Uncommon (may affect up to 1 in 100 people)

– gastroenteritis (inflammation of the gastrointestinal tract that involves both the stomach and small intestine/stomach flu), upper respiratory infection, urinary tract infection,

– changes in laboratory values (decreased number of red blood cells, decreased number of white blood cells, platelets decreased),

– hypersensitivity (an allergic reaction including hives which may be serious enough to require immediate medical attention),

– appetite increases or decreases, weight gain,

– anxiety, depression, decreases in mental sharpness; seeing, feeling or hearing things that are not there (hallucinations),

• – taste alteration, inability to sleep, numbness or tingling, sleepiness,

• – blurred vision, eye irritation and redness,

• – ringing in the ears, vertigo (sensation of spinning while remaining still),

• – abnormal heart rhythm (atrial fibrillation), fast heart rate, heart failure, non-specific ECG changes, feeling of tightness, pressure or heaviness in the chest (angina pectoris), heart attack,

• – flushing, stroke, mini-stroke (transient ischaemic attack), severe increase in blood pressure,

• – inflammation of the blood vessels,

• – cough, breathlessness, nose bleed,

• – stomach or bowel bloating, changes in your bowel habits, dry mouth, stomach ulcer, inflammation of the stomach lining that can become serious and may lead to bleeding, irritable bowel syndrome, inflammation of the pancreas,

• – swelling of the face, skin rash or itchy skin, redness of the skin,

• – muscle cramp/spasm, muscle pain/stiffness,

• – high levels of potassium in your blood, changes in blood or urine tests relating to your kidney, serious kidney problems, increased levels of uric acid and creatine phosphokinase,

• – chest pain.

Rare (may affect up to 1 in 1,000 people)

– angioedema (an allergic reaction with swelling of the face, lips, tongue and/or throat which may cause difficulty in breathing or swallowing, which may be serious enough to require immediate medical attention)/anap­hylactic/anap­hylactoid reactions including shock (a serious allergic reaction that requires immediate medical attention),

• – confusion, restlessness,

• – liver problems (hepatitis),

• – low blood levels of sodium,

• – liver failure, yellowing of the skin and/or eyes (jaundice),

• – severe skin reactions (these reactions can involve ulcers of the mouth, throat, nose and genitals; the rash may progress to widespread blistering and peeling of the skin).

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at:. By reporting side effects you can help provide more information on the safety of this medicine.

5. how to store etoricoxib

Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the pack after EXP. The expiry date refers to the last day of that month.

This medicine does not require any special storage conditions.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. contents of the pack and other information what etoricoxib film-coated tablets contain

The active substance is etoricoxib.

Each film-coated tablet contains 30, 60, 90 or 120 mg of etoricoxib.

The other ingredients are:

Tablet core: Calcium hydrogen phosphate, anhydrous; Cellulose microcrystalline; Croscarmellose sodium; Silica colloidal anhydrous; Talc; Magnesium stearate

Film coat: Hypromellose; Hydroxypropyl­cellulose;

Macrogol 6000; Talc; Titanium dioxide E171 The 60 mg tablets also contain brown ferric oxide E172, the 90 mg tablets also contain yellow ferric oxide E172 and 120 mg tablets also contain red ferric oxide E172.

What Etoricoxib film-coated tablets look like and contents of the pack

Etoricoxib 30 mg film-coated tablets:

White to off white round biconvex film-coated tablets, approx. 6 mm in diameter.

Etoricoxib 60 mg film-coated tablets:

Light brown round biconvex film-coated tablets, approx.

• 8 mm in diameter.

Etoricoxib 90 mg film-coated tablets:

Light yellow round biconvex film-coated tablets, approx.

• 9 mm in diameter.

Etoricoxib 120 mg film-coated tablets:

Light pink round biconvex film-coated tablets, approx.

• 10 mm in diameter.