# Etoricoxib and its hidden risks: a case-based review of dermatological, hematological, and cardiovascular complications

## TL;DR

This review highlights rare but serious side effects of etoricoxib, including skin, blood, and heart complications, emphasizing the need for careful monitoring and drug evaluation.

## Contribution

The paper consolidates case-based evidence to evaluate the causality and clinical implications of etoricoxib's rare but severe adverse effects.

## Key findings

- Etoricoxib is linked to severe dermatological reactions like SJS and TEN, which involve widespread skin detachment.
- Hematological complications such as thrombocytopenia and immune hemolytic anemia can occur shortly after starting the drug.
- Cardiovascular risks, including atrial fibrillation and hypertension, are associated with etoricoxib's COX-2 selectivity.

## Abstract

This review analyzes case reports of adverse drug reactions (ADRs) attributed to etoricoxib, with particular emphasis on Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), fixed drug eruptions (FDE), atrial fibrillation, hypertension, thrombocytopenia (TP), immune hemolytic anemia (IHA), acute generalized exanthematous pustulosis (AGEP), maculopapular rash, pretibial erythema with edema, and reversible cerebral vasoconstriction syndrome (RCVS). Although infrequent, these severe hypersensitivity and cardiovascular events pose significant clinical risks due to their association with substantial morbidity and, in some cases, mortality. The primary aim of this review is to consolidate available clinical evidence to evaluate the causality, characteristic clinical presentations, and broader safety implications of etoricoxib in relation to these adverse outcomes. While SJS/TEN are marked by widespread epidermal necrosis and detachment, FDE typically recurs at fixed sites with residual pigmentation. Hematological complications such as drug-induced (TP) and Drug-induced IHA have also been reported, presenting as sudden platelet decline or severe hemolysis, respectively. These adverse effects often appear within hours to weeks of initiating therapy. Cutaneous manifestations, including exanthematous pustulosis and maculopapular rashes, further complicate the drug's safety profile. Etoricoxib's pro-thrombotic potential, possibly linked to COX-2 selectivity, remains a cardiovascular concern. Causality assessments via the Naranjo Scale and WHO-UMC often support a probable link. These findings underscore the necessity for careful evaluation of patient history, immediate drug discontinuation upon clinical suspicion, and strengthened pharmacovigilance systems to better capture and characterize the full range of these rare yet serious reactions.

See also the graphical abstract(Fig. 1).