In Brief
| Etoricoxib (Arcoxia) | |
|---|---|
| Class | Selective COX-2 inhibitor (coxib) |
| NNT at 120 mg | 1.8 (95% CI 1.7–2.0) — best among non-opioids |
| What it was measured on | Acute postoperative pain, single dose, 6 hours |
| In dental pain | 1.6 (1.5–1.8) — intervals overlap with the overall figure |
| Doses | 30, 60, 90, 120 mg |
| Supply | Prescription-only in Germany, France and Italy |
| EU restriction | 120 mg — acute gout attack only, short course |
Etoricoxib carries the best figure of any non-opioid painkiller covered by the Cochrane single-dose reviews. Its NNT is 1.8: fewer than two people need treating for one of them, over and above placebo, to have their pain at least halved.
The number is impressive, which is why it deserves to be understood precisely.
What Was Actually Measured
Six studies of the 120 mg dose entered the review, with 798 participants. The result: 66% of those on etoricoxib had their pain at least halved, against 12% on placebo. Hence the NNT of 1.8. The authors rated the certainty of evidence as high.
But that figure has a precise address, and the address already limits it:
- The pain is acute and postoperative — not headache, not menstrual, not back pain.
- The dose is single, not a course.
- The observation window is six hours.
- The outcome is calculated, not measured directly: the proportion was derived from the area under the pain-relief curve using validated equations.
The 1.8 cannot be carried to other kinds of pain — not because the drug fails there, but because this review holds no such data.
About Dental Pain
The separately calculated figure for dental studies is an NNT of 1.6 (95% CI 1.5–1.8), nominally better than the overall 1.8 (1.7–2.0).
This is where a mistake is easy, and it is made often. The two confidence intervals overlap, and the review reports no formal test of the difference between subgroups. So saying «etoricoxib works better for dental pain» is not permitted: the difference exists on paper and is not statistically established.
How Far Ahead of the Others It Really Is
The Cochrane overview that pooled 39 reviews, some 460 studies and roughly 50,000 participants contains a sentence worth recalling whenever a painkiller ranking appears: no statistical comparison between drugs was undertaken.
Of the five drugs in this series, etoricoxib is the only one whose interval does not overlap those of naproxen and ketoprofen. So it does separate from the bottom of the list. Within the middle, however, the order is not established by the numbers: the intervals overlap, and position there owes as much to chance as to pharmacology.
Where It Is Sold
- Germany — registered, prescription-only.
- France — registered, prescription-only; 30 and 60 mg plus generics.
- Italy — 384 packs under sixteen trade names (Arcoxia, Algix, Tauxib and generics), doses of 30, 60, 90 and 120 mg. Not one over-the-counter pack.
An important detail about the 120 mg. In the European Union that dose is authorised only for an acute attack of gouty arthritis, and only as a short course. Other indications use the smaller strengths. Which means the NNT of 1.8, obtained precisely at 120 mg, describes a dose that is not always the one prescribed.
Safety
Etoricoxib selectively inhibits COX-2, so the stomach tolerates it better than non-selective NSAIDs. Selectivity does not cancel the class effects, and those are worth knowing:
- Cardiovascular risk. Selective COX-2 inhibitors call for caution in coronary disease, previous stroke and uncontrolled hypertension.
- Blood pressure. The drug can raise it; monitoring is needed in hypertension.
- Kidneys. Like all NSAIDs it reduces renal blood flow; caution in chronic kidney disease and dehydration.
- Never take two NSAIDs together. The analgesia does not add up; the risk to stomach and kidneys does.
The Bottom Line
Etoricoxib is legitimately a strong drug, and its figure is honest. It simply describes a narrow situation: one dose, acute pain after surgery, over six hours.
That makes it a sound choice where pain is expected to be severe and short — and does not make it a universal «strongest painkiller». It is prescription-only in all three countries, and the decision belongs to a doctor weighing cardiovascular risk, blood pressure and kidney function.
About buying
The drug is in the catalogue: Arcoxia (etoricoxib) 90 mg. No price is shown — prescription medicines are ordered through the chat, and the administrator confirms availability and cost. The prescribing stays with a doctor: this guide explains what is known about the drug, it does not replace a consultation.
