Pain control এর জন্য আমরা মূলত ২ টা গ্রুপের Drug ব্যবহার করি।

1. Opoid Analgesics
2. NSAIDs

তো এই NSAIDs এর মাঝে দুটো গ্রুপ আছে। আমাদের শরীরে Prostaglandin বইলা একটা জিনিস আছে যেটা মূলত Pain sensation এ কাহিনী করে। তো Cell membrane এ Phospholipid থাকে অইটা থিকাই আসে Prostaglandin। তো এইখানে Cylcooxygenase অর্থাৎ Cox enzyme কাজ করে। Flow chart এ বুঝা যাবে সহজে

Prostaglandin Synthesis from Phospholipids

Cell Membrane Phospholipids

↓ (Stimulated by injury/inflammation)

Phospholipase A2 Activation

(Enzyme activated by stimuli like trauma, cytokines, etc.)

↓

Release of Arachidonic Acid

(Freed from phospholipid bilayer)

↓

Cyclooxygenase (COX) Pathway Begins

↓

COX-1 and COX-2 Convert Arachidonic Acid → PGG2

(PGG2 = Prostaglandin G2, unstable intermediate)

তো এইখানে একটা মজার কাহিনী বলি। Steroid drugs গুলো কিন্তু Phospholipase A2 কে ব্লক করে এজন্য Steroid ব্যবহার এ সকল PG একসাথে অফ হয়। এজন্য স্টেরয়েড গুলোর সাইডইফেক্ট অনেক বেশি হয়।

তো আসি আসল কথায়….

NSAIDs গুলো দুইভাবে কাজ করে ১ টা হইল Non Selective NSAIDs অর্থাৎ Cox-1 and Cox-2 দুইটাকেই বIntroductাট কাহিনী হচ্ছে Cox-1 এর বিভিন্ন ফাংশ আছে৷ যেমন GIT Protection, Renal Function এর রোল আছে। যদি আপনি Non Selective দেন তখন কিন্তু এই জায়গাগুলো আবার সমস্যায় পড়বে।

আরেকটা গ্রুপ আছে যারা শুধু Cox-2 কে ব্লক করে।অর্থাৎ Selective Cox-2 Inhibitor যারা শুধু Cox-2 কে ব্লক করে। ফলে Pain বন্ধ হইলেও GIT তে তেমন ইফেক্ট পড়েনা। আপনি ভাবতে পারেন তাইলে শুধু এইটাই তো ভালো। না না এত সোজা না, এ আবার CVS এ যায়া গ্যাঞ্জাম লাগায়। Cox-2 inhibitor গ্রুপের সকল Drug omit হয়ে গেলেও একটা Drug আছে যেটা Still ব্যবহার করা হয়। সেটাই হচ্ছে Etoricoxib (বাজারে Etorix, Tory ইত্যাদি নামে পাওয়া যায়) চলুন এই ব্যাটাকে নিয়ে একটা Overview দেই।

Etoricoxib

A Selective COX-2 Inhibitor in Modern Pain Management

Etoricoxib is a selective COX-2 inhibitor belonging to the class of NSAIDs . It is commonly used for the treatment of various inflammatory and painful conditions with a lower gastrointestinal side effect profile compared to traditional NSAIDs.

Mechanism of Action

Etoricoxib selectively inhibits COX-2, an enzyme induced during inflammation and responsible for prostaglandin synthesis.

Unlike non-selective NSAIDs, it spares COX-1, which plays a protective role in the gastric mucosa, platelet function, and renal blood flow.

This selectivity leads to effective pain relief and anti-inflammatory effects with reduced risk of gastric ulcers and bleeding.

Pharmacokinetics

Absorption: Rapid oral absorption; peak plasma concentration within 1 hour.

Bioavailability: Approximately 100%.

Half-life: ~22 hours, allowing once-daily dosing.

Metabolism: Primarily hepatic via CYP enzymes (mainly CYP3A4).

Excretion: Mainly via urine

Indications

Etoricoxib is indicated in adults for

1. Osteoarthritis
2. Rheumatoid arthritis
3. Ankylosing spondylitis
4. Acute gouty arthritis
5. Acute pain, including postoperative pain
6. Chronic low back pain
7. Primary dysmenorrhea

Adverse Effects

Though better tolerated than traditional NSAIDs in terms of GI effects, Etoricoxib may still cause:

Cardiovascular: Hypertension, edema, increased risk of thrombotic events (MI, stroke)

Renal: Sodium retention, renal impairment (especially in elderly or pre-existing renal disease)

Gastrointestinal: Dyspepsia, abdominal pain, diarrhea (lower incidence than NSAIDs)

Hepatic: Elevated liver enzymes (monitor in long-term use)

Allergic reactions: Rare but possible (rash, anaphylaxis)

Contraindications

Active peptic ulcer or GI bleeding

Severe hepatic or renal impairment

Uncontrolled hypertension

Established ischemic heart disease, cerebrovascular disease, or peripheral artery disease

Pregnancy and lactation (especially 3rd trimester)

Special Considerations

Cardiovascular Risk: Unlike traditional NSAIDs, selective COX-2 inhibitors like Etoricoxib may increase cardiovascular risk. Use with caution in patients with risk factors (hypertension, diabetes, dyslipidemia, smoking).

Renal Function: Monitor in elderly and those with pre-existing renal dysfunction.

Hepatic Monitoring: Avoid in severe hepatic dysfunction; adjust dose in moderate hepatic impairment.

Raiyyan Tahsan. Date:-17-04-2025 Thursday Time:-11-55-45 Pm.

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