Tory (Etoricoxib): A Selective COX-2 Inhibitor for Pain and Inflammation

Tory contains Etoricoxib, a potent and orally active cyclooxygenase-2 (COX-2) specific inhibitor. It is indicated for the symptomatic relief of pain and inflammation in a variety of conditions, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute gouty arthritis, and short-term management of post-dental surgery pain. As a selective COX-2 inhibitor, it is designed to reduce pain and inflammation with a decreased potential for gastrointestinal side effects compared to nonselective NSAIDs. It is a type of NSAID.

How Tory Works (Pharmacology)

Tory works by selectively targeting the enzyme responsible for inflammatory pain:

• Selective COX-2 Inhibition: It specifically inhibits the COX-2 enzyme, which is primarily responsible for producing prostaglandins that cause pain, inflammation, and fever.
• Spares COX-1: Unlike traditional NSAIDs, Tory has minimal effect on the COX-1 enzyme, which is responsible for protective functions like maintaining the stomach lining and promoting blood clotting.
• Reduced Side Effects: This selective action helps to relieve symptoms with a lower risk of gastric damage and effects on platelet aggregation.

Key Indications & Benefits

Tory is indicated for the symptomatic relief of:

• Osteoarthritis (OA)
• Rheumatoid arthritis (RA)
• Ankylosing spondylitis
• Acute gouty arthritis
• Moderate pain associated with dental surgery (for a maximum of 3 days)

Dosage & Administration

The dosage of Tory varies depending on the condition being treated. The lowest effective dose for the shortest duration possible should be used, especially in patients with cardiovascular risk factors. Always consult a registered physician for specific dosage instructions.

• Osteoarthritis: 30 mg once daily, may be increased to 60 mg once daily.
• Rheumatoid Arthritis & Ankylosing Spondylitis: 90 mg once daily.
• Acute Gouty Arthritis: 120 mg once daily, for a maximum of 8 days.
• Postoperative dental surgery pain: 90 mg once daily, for a maximum of 3 days.

Important Considerations & Warnings

It is crucial to discuss your full medical history with your doctor before taking Tory.

Contraindications:

• Hypersensitivity to Etoricoxib or any excipients.
• Active peptic ulceration or gastrointestinal bleeding.
• History of asthma, urticaria, or allergic reactions after taking aspirin or other NSAIDs.
• Pregnancy and lactation.
• Severe hepatic dysfunction or renal impairment (creatinine clearance < 30 ml/min).
• Congestive heart failure (NYHA II-IV).
• Uncontrolled hypertension (>140/90 mmHg).
• Established ischemic heart disease, peripheral arterial disease, and/or cerebrovascular disease.
• Children and adolescents under 16 years of age.
• Inflammatory bowel disease.

Side Effects:

• Common: Palpitation, fatigue, flu-like symptoms, bruising.
• Less common: Dry mouth, taste disturbance, mouth ulcers, weight changes, atrial fibrillation, chest pain, anxiety.
• Rare: Confusion and hallucinations.

Pregnancy & Lactation:

• Pregnancy: Tory is not recommended for women who are pregnant or attempting to conceive.
• Lactation: It is not known if it is excreted in human milk. However, due to excretion in rat milk, women taking Tory must not breastfeed.

Precautions & Warnings:

• Gastrointestinal Risk: Use caution in patients at risk of GI complications, such as the elderly or those with a history of ulcers.
• Cardiovascular Risk: The risk of cardiovascular events may increase with dose and duration. Use with caution in patients with risk factors like hypertension, diabetes, or a history of heart disease.
• Renal Function: It may impair renal function. Monitoring is recommended, especially in high-risk patients.
• Hypertension: Blood pressure should be monitored regularly, especially in the first two weeks of treatment.
• Liver Function: Liver function tests should be monitored. Discontinue use if signs of hepatic insufficiency appear.
• Hypersensitivity: Discontinue at the first sign of a skin rash or other allergic reactions.
• Masking Symptoms: Tory may mask fever and other signs of inflammation.

Drug Interactions:

• Oral anticoagulants (e.g., Warfarin): Can increase prothrombin time.
• Diuretics, ACE inhibitors: NSAIDs may reduce their antihypertensive effects.
• Low-dose Aspirin: Can be taken together, but with caution due to increased risk of side effects.
• Lithium: May increase lithium plasma levels.

Overdose Effects

• Overdose symptoms are generally not serious. The most common signs are gastrointestinal issues.
• In the event of an overdose, symptomatic and supportive measures should be taken.

Storage Conditions

Store at a temperature of below 30°C, protected from light and moisture. Keep out of reach of children.