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Pharmacokinetics of Etoricoxib in Patients with Hepatic Impairment

From Merck Research Laboratories, West Point, Pennsylvania (Dr. Agrawal, Dr. Rose, Ms. Matthews, Dr. Woolf, Dr. Porras, Ms. Geer); Merck Research Laboratories, Rahway, New Jersey (Mr. Larson, Ms. Cote, Dr. Gottesdiener); Merck Research Laboratories, Blue Bell, Pennsylvania (Dr. Petty); Clinical Pharmacology Associates, Miami, Florida (Ms. Dilzer, Dr. Lasseter); and Center for Clinical Research, Austin, Texas (Dr. Alam).

The effect of hepatic insufficiency on the pharmacokinetics of etoricoxib, a selective inhibitor of cyclooxygenase-2, was investigated following administration of single and multiple oral doses to mild hepatic insufficiency patients (Child-Pugh score of 5 to 6), multiple oral doses to moderate hepatic insufficiency patients (Child-Pugh score of 7 to 9), and single intravenous doses to both mild and moderate hepatic insufficiency patients. A trend of decreasing systemic clearance with increasing hepatic impairment was observed. Absorption of etoricoxib was unaffected by hepatic impairment. Binding of etoricoxib to plasma proteins was also found to be unaffected by hepatic disease. Etoricoxib was generally well tolerated by patients with mild and moderate hepatic insufficiency. Together, these results support a 60-mg once-daily dosing regimen for mild hepatic insufficiency patients and a 60-mg every-other-day dosing regimen for moderate hepatic insufficiency patients. There are no clinical or pharmacokinetic data in patients with severe hepatic insufficiency (Child-Pugh score > 9).

Key Words: Etoricoxib • pharmacokinetics • hepatic impairment • bioavailability • cyclooxygenase • COX-2

Address for reprints: Dr. Nancy G. B. Agrawal, Department of Drug Metabolism, WP75-200, Merck Research Laboratories, West Point, PA 19486.

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