Etoricoxib is effective for pain relief, but due to its cardiovascular and gastrointestinal risks, there are clear contraindications for its use.

I. Absolute contraindications: who must not use it

1. Allergy to etoricoxib or any excipients

Patients who have previously experienced rash, urticaria, angioedema, or anaphylactic shock after using etoricoxib or its excipients are contraindicated.

2. Allergy to non-steroidal anti-inflammatory drugs (NSAIDs)

(1) Including those allergic to aspirin or other COX-2 inhibitors.

(2) Such patients may have cross-allergy, inducing severe bronchospasm or anaphylactic reactions.

3. Active peptic ulcer or bleeding

Patients currently with gastric or duodenal ulcer, or active gastrointestinal bleeding are contraindicated, as the drug may aggravate mucosal damage leading to massive hemorrhage or perforation.

4. Severe liver disease

Patients with severe hepatic impairment are contraindicated, as impaired drug metabolism may increase the risk of toxic accumulation.

5. Severe kidney disease

Patients with severe renal insufficiency are contraindicated, as etoricoxib may further reduce renal blood flow and worsen renal damage.

6. Established cardiovascular and cerebrovascular diseases

(1) Including moderate to severe heart failure, angina pectoris, history of myocardial infarction, post-coronary artery bypass grafting, peripheral arterial disease, and any type of stroke (including transient ischemic attack).

(2) Etoricoxib may slightly increase the risk of thrombotic events, and the risk is significantly higher in those with established disease history.

7. Inflammatory bowel disease

Patients with active Crohn's disease or ulcerative colitis are contraindicated, as the drug may induce or exacerbate intestinal inflammation and bleeding.

8. Pregnancy and lactation

Contraindicated throughout pregnancy, especially in the third trimester (may cause premature closure of the fetal ductus arteriosus). Breastfeeding should be stopped during the medication period.

9. Children and adolescents under 16 years of age

Safety and efficacy have not been established in this age group; use is prohibited.

II. Relative contraindications and cautious use requiring physician evaluation

1. Uncontrolled hypertension

Contraindicated in patients with untreated or poorly controlled hypertension.

2. History of peptic ulcer or bleeding

Patients with a prior history of ulcer or bleeding have increased risk of recurrence; use with caution and consider concomitant gastric mucosal protective agents.

3. Dehydration

In cases of severe vomiting, diarrhea, or inadequate fluid intake leading to dehydration, the risk of renal injury is increased; dehydration should be corrected before evaluating drug use.

4. Heart failure or cardiac history

Even if not meeting criteria for moderate heart failure, patients with cardiac history should be cautious, as the drug may induce fluid retention and cardiac decompensation.

5. Concomitant cardiovascular risk factors

Patients with diabetes, hypercholesterolemia, or smoking have higher baseline risk of myocardial infarction and stroke; the benefit-risk balance should be carefully weighed when using etoricoxib.

6. Infectious diseases

Etoricoxib may mask fever and delay diagnosis of infection; therefore, use with caution during treatment of infections and closely monitor clinical status.

7. Women planning pregnancy

The drug may affect ovulation and implantation; use is not recommended in women planning to become pregnant.

III. Medication management recommendations for special populations

1. Hepatic impairment

(1) In patients with mild hepatic impairment, the daily dose should not exceed 60 mg; in moderate hepatic impairment, the daily dose should not exceed 30 mg.

(2) Severe hepatic impairment is contraindicated. Liver enzymes should be regularly monitored during treatment.

2. Renal impairment

(1) In patients with mild to moderate renal insufficiency, conventional doses may be used, but serum creatinine, potassium, and urine output should be monitored.

(2) Severe renal disease is contraindicated. In patients concurrently using diuretics or ACE inhibitors, the risk of renal injury is additive and requires special caution.

3. Elderly patients aged 65 years and older

(1) No routine dose adjustment is needed, but elderly patients often have multiple comorbidities and polypharmacy, with reduced cardiac and renal reserve.

(2) Physicians should strengthen regular assessments of blood pressure, renal function, and gastrointestinal symptoms.

4. Children and adolescents

Use is prohibited in those under 16 years of age.

5. Pregnant and lactating women

(1) Contraindicated in pregnant or planning-to-become-pregnant women.

(2) If use during lactation is necessary, breastfeeding should be suspended until an adequate time after drug discontinuation.

6. Special reminders for concomitant medications

In patients using anticoagulants (warfarin), immunosuppressants (cyclosporine, tacrolimus), lithium, digoxin, or oral contraceptives, concomitant use of etoricoxib may alter the blood concentrations of these drugs or enhance toxicity; enhanced monitoring is required.