Kretos

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Medically reviewed

Marina Burgos

Last updated on 22/12/2025

This page provides general, reference-level information compiled from official medical sources. It is not a substitute for professional medical advice, diagnosis, or treatment. For decisions about your health, please consult a qualified healthcare professional.

Overview of Kretos

What is Kretos?

Kretos is a pharmaceutical medication containing the active substance entacapone. It belongs to a class of drugs known as catechol-O-methyltransferase (COMT) inhibitors. This medication is used in the management of Parkinson’s disease symptoms, specifically to assist other primary treatments.

Mechanism of Action

In Parkinson’s disease, the brain lacks sufficient levels of dopamine. Most treatments involve providing levodopa, a substance that the body converts into dopamine. However, certain enzymes in the body naturally break down levodopa before it can reach the brain.

Kretos works by blocking the COMT enzyme. By inhibiting this enzyme, the medication prevents the premature breakdown of levodopa in the bloodstream. This allows a larger and more consistent amount of levodopa to reach the brain, where it can be converted into dopamine to help regulate body movements.

Therapeutic Application

Kretos is not used as a standalone therapy. It is administered as an adjunct to standard levodopa/benserazide or levodopa/carbidopa preparations. It is typically introduced when patients experience "wearing-off" effects, a phenomenon where the benefits of a levodopa dose diminish before the next dose is due, leading to a return of Parkinsonian symptoms such as tremors, stiffness, or slow movement.

By stabilizing the levels of levodopa in the system, Kretos helps extend the duration of the clinical effect of each dose, contributing to better management of motor fluctuations throughout the day.

What side effects are possible with Kretos?

Possible Side Effects and Safety Information

The safety profile of Kretos, which contains the active substance Etoricoxib, is based on official classifications from regulatory authorities, documenting potential adverse reactions across multiple organ systems. These classifications detail the expected frequency of occurrence.

The most common adverse reactions reported are often related to the Gastrointestinal System, with abdominal pain classified as Very Common. Other frequent effects (Common) include fluid retention (oedema), headache, and hypertension (high blood pressure).


Serious Safety Considerations and Restrictions

Official labeling highlights the potential for serious adverse reactions, particularly those affecting the cardiovascular and gastrointestinal systems. These reactions, though generally Uncommon or Rare, include myocardial infarction (heart attack), stroke, and gastrointestinal perforation, ulceration, or bleeding. The risk of serious cardiovascular events is documented to increase with both the dose and the duration of exposure.

Contraindications define high-risk situations where the medicine must not be used. Kretos is strictly contraindicated for individuals with established ischaemic heart disease, cerebrovascular disease, severe hepatic or renal impairment, uncontrolled hypertension (blood pressure persistently above 140/90 mmHg), or congestive heart failure (NYHA Class II-IV). It is also contraindicated during pregnancy and in adolescents under 16 years of age. These restrictions confirm that the official safety profile prioritizes the avoidance of high-risk use in vulnerable populations.

Overdose and Emergency Response

Overdose and When to Seek Help

Official regulatory information for Etoricoxib, the active ingredient in Kretos, details the expected clinical presentation and mandated emergency actions in the event of an overdose.

Overdose cases are primarily documented to manifest as gastrointestinal disturbances, including nausea, vomiting, and diarrhea, along with generalized somnolence (drowsiness). While many exposures may result in these non-specific effects, the drug’s regulatory profile acknowledges the potential for severe outcomes associated with the NSAID class, such as Gastrointestinal haemorrhage and Acute renal failure.


Required Emergency Action

Official instructions mandate that patients must seek immediate medical attention and contact emergency services if an overdose is suspected, as emergency medical care is required. This urgent action is necessary because no specific antidote is known or available for Etoricoxib.

Management procedures, as described in regulatory documents, involve symptomatic and supportive treatment. Measures such as the use of activated charcoal or procedures for gastric emptying may be considered based on the severity and time of ingestion. Clinical observation and hospital monitoring may be required until the patient's condition stabilizes.

Therapeutic Uses of Kretos

What Kretos Treats: Main Uses and Benefits

Kretos is a therapeutic option applied across domains where additional symptomatic support is needed to address both pain and inflammation. Its core purpose is to provide symptomatic relief in clinical settings marked by heightened distress and when symptoms interfere with daily functioning. This medication is commonly used in situations involving certain distressing symptoms and conditions characterized by periods of heightened symptoms.


Key Therapeutic Focus

Kretos is generally used in conditions involving episodic or fluctuating manifestations, including Osteoarthritis (OA), Rheumatoid Arthritis (RA), and Ankylosing Spondylitis (AS). It is also applied in acute contexts, such as the acute episodes of Gouty Arthritis (gout attacks) or for short-term symptomatic assistance following dental surgery. It is used for managing symptom clusters that may become intense or disruptive, including persistent joint pain, stiffness, and swelling.


Quick Facts

Quick Fact Relief for
Primary Focus Inflammatory and chronic joint pain
Acute Use Gout attacks, post-dental surgery discomfort
Patient Goal Supports functional stability and comfort

Eligibility and Restrictions for Use

Eligibility Map: Who Can and Cannot Use Kretos — Official Regulatory Information

Regulatory agencies define strict criteria for the use of Kretos (Etoricoxib). The medicine is indicated for use only in adults and adolescents 16 years of age and older for symptomatic relief.


Populations for whom use is Contraindicated

Kretos is strictly prohibited in patients with the following conditions, as confirmed by regulatory labels:

  • Established Cardiovascular Disease: This includes established ischaemic heart disease, cerebrovascular disease (such as stroke or TIA), peripheral arterial disease, or congestive heart failure (NYHA Class II-IV).
  • Uncontrolled Hypertension: Blood pressure persistently elevated above 140/90 mmHg that has not been adequately controlled.
  • Active GI Disease: Active peptic ulceration, active gastrointestinal bleeding, or inflammatory bowel disease.
  • Severe Organ Impairment: Severe hepatic dysfunction (Child-Pugh score ge 10) or severe renal impairment (creatinine clearance < 30 mL/min).
  • Hypersensitivity: Known allergy to Etoricoxib, excipients, or allergic reactions (e.g., bronchospasm) to Aspirin or other NSAIDs.

Age and Physiological Restrictions

Population Regulatory Status
Children (lt 16 years) Contraindicated
Pregnancy Contraindicated
Lactation/Breastfeeding Contraindicated
Women Attempting to Conceive Not Recommended

Eligibility-Related Restrictions

Patients with known cardiovascular risk factors (e.g., smoking, diabetes, hyperlipidaemia, or controlled hypertension) should only be treated after careful consideration, using the lowest effective dose for the shortest duration. Patients with mild or moderate hepatic dysfunction are eligible only with specific, officially defined dose limitations.

What should I know about interactions with other medicines?

Interactions with other medicines and products

The interaction profile of Kretos (Etoricoxib) is documented in regulatory sources and defined by effects on drug exposure and pharmacodynamic outcomes.

Documented Interaction Patterns

Co-administration with Rifampin, a medicine classified as a potent inducer of hepatic metabolism, causes a significant decrease (65%) in Etoricoxib's systemic exposure (AUC). Conversely, Etoricoxib increases the exposure of co-administered Ethinyl Estradiol (a component of oral contraceptives) by 50% to 60%.

Etoricoxib also has pharmacodynamic interactions with several classes of medicines. When co-administered with Oral Anticoagulants such as Warfarin, an increase in the International Normalized Ratio (INR) is officially documented, which requires monitoring. Similarly, combining Etoricoxib with Diuretics, ACE Inhibitors, or Angiotensin II Antagonists (AIIAs) may diminish the desired blood pressure or fluid balance effects of those medicines. Furthermore, in patients who are elderly, volume-depleted, or have underlying renal impairment, this combination may increase the risk of renal function deterioration.

Official Restrictions

Regulatory documents stipulate that co-administration with other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), including other COX-2 selective inhibitors, is generally restricted due to a heightened risk of serious gastrointestinal adverse events. While a high-fat meal may delay the rate of absorption (Tmax), it has no clinically significant effect on the total extent of absorption (AUC).

Mechanism of Action

Selective Molecular Blockade of the COX-2 Enzyme System

Kretos operates through the highly selective inhibition of the Cyclooxygenase-2 ( COX-2) enzyme. This COX-2 target is principally induced during inflammatory processes and is responsible for initiating the synthesis of key chemical messengers that mediate nociception and inflammatory vascular responses. The Etoricoxib molecule is designed to bind to the COX-2 active site while largely sparing the constitutive COX-1 enzyme, which mediates gastric mucosal integrity and platelet aggregation.

The inhibition of COX-2 halts the enzymatic conversion of Arachidonic Acid into pro-inflammatory Prostaglandins ( PGE2). This molecular interruption is the core mechanistic cascade, leading to a downstream reduction in the levels of these mediators. Physiologically, this reduction results in decreased sensitization of peripheral nociceptors and decreases the prostaglandin-driven increase in vascular permeability, thereby modulating the systemic pro-inflammatory response.

The COX-2 selective mechanism also influences the balance between eicosanoids. The resultant shift in prostaglandin ratios impacts the COX-2-mediated regulation of processes, including the PGI2 component involved in renal blood flow.

Dosage and Administration Information

How to Use Kretos

Kretos (Etoricoxib) is a medication formulated for oral administration only, supplied as a film-coated tablet in strengths of 30 mg, 60 mg, 90 mg, and 120 mg. The tablet must be swallowed whole with liquid and may be taken with or without food; however, administration without food may result in a faster onset of action, a factor often considered for acute symptom relief.


Standard Dosing and Frequency

Etoricoxib is dosed once daily for all approved indications. The specific dose and treatment duration are strictly dependent on the condition being addressed:

Condition Standard Daily Dose (Maximum) Duration Constraint
Osteoarthritis (OA) 30 mg or 60 mg Use the lowest effective dose for the shortest period.
Rheumatoid Arthritis (RA) / Ankylosing Spondylitis (AS) 60 mg or 90 mg Treatment need must be re-evaluated periodically.
Acute Gouty Arthritis 120 mg Limited to a maximum of 8 days.
Postoperative Dental Pain 90 mg Limited to a maximum of 3 days.

Population-Specific Guidelines

For the chronic management of OA, RA, and AS, management involves using the lowest effective dose and requires periodic re-evaluation of the necessity for continued symptomatic use. Dosage adjustments are specifically required for patients with hepatic impairment, where the maximum dose is limited to 60 mg daily for mild impairment and 30 mg daily for moderate impairment. Etoricoxib is not approved for use in individuals under the age of 16. If a dose is missed, patients should resume the regular once-daily schedule with the next dose, without taking a double dose.

Recent Clinical Evidence

Research Evidence / Overview of Studies

Summary of Activity and Study Profiles

Studies evaluated the drug's activity in clinical settings. Research has explored the drug's profile in relation to acute pain episodes.

  • In a large-scale randomized controlled trial (RCT), research examined whether the drug was associated with differences in patient-reported pain scores within 30 minutes of administration.
  • Studies have included diverse patient populations.
  • Long-term use studies have tracked levels of chronic inflammatory markers. Research is exploring underlying conditions in relation to the drug.

Studies Related to Specific Pain Conditions

Osteoarthritis (OA) Pain

For pain due to osteoarthritis, studies evaluated whether the drug affects pain and stiffness. Findings included differences in observed pain and stiffness when compared to placebo.

Post-Surgical Pain

Research has explored whether the drug may affect the need for rescue analgesia in patients recovering from minor surgical procedures. Initial findings have been mixed, with published studies noting the need for further, larger-scale studies.


Safety and Patient Profile Research

Studies have examined this treatment in adults with acute pain. Comparative research on treatment profiles is conducted by regulatory bodies and researchers.

  • Gastrointestinal Tracking: Several small studies have explored how the drug was managed by patients. While results explored how the drug was managed by patients, some patients reported mild, temporary nausea.
  • Hepatic Considerations: Studies have addressed patient profiles, including those with a history of severe liver disease.

Frequently Asked Questions (FAQ)

Common questions about Kretos (FAQ)

Q: What happens if I forget to take a dose of Kretos?

A: Official administration guidelines state that if a dose is missed, a person is directed to resume their regular once-daily schedule with the next dose. It is officially advised that a double dose not be taken to compensate for the missed dose.


Q: Can women who are planning to become pregnant use Kretos?

A: The official product information states that the use of this medicine is not recommended for women who are actively attempting to conceive. This is consistent with its official classification as an inhibitor of cyclooxygenase/prostaglandin synthesis, which is a factor in reproductive health.


Q: Why do some people experience initial tiredness when starting Kretos?

A: Official regulatory documents list fatigue, asthenia (weakness or lack of energy), and somnolence (sleepiness) as commonly reported adverse effects. These effects are part of the known safety profile described in the product information.


Q: How is Kretos cleared from the body?

A: Pharmacological studies indicate that the active ingredient is primarily cleared from the body through an extensive process of metabolism, or chemical change. The resulting compounds are then mostly eliminated through urine and feces, with only a small fraction of the drug passing through the body unchanged.


Q: How long does Kretos stay in your system?

A: Based on clinical data, the elimination half-life of the active ingredient is approximately 20 to 25 hours. The half-life is the time it takes for the amount of medicine in the bloodstream to be reduced by half.


Q: Is Kretos a narcotic or a controlled substance?

A: Kretos is classified as a Nonsteroidal Anti-Inflammatory Drug (NSAID) and is a selective Cyclooxygenase-2 (COX-2) inhibitor. It is not listed as a narcotic or controlled substance by government regulatory agencies that regulate substances with potential for abuse.


Q: What should I know about taking Kretos if I have other health issues?

A: Official guidelines emphasize that caution is required for individuals with significant risk factors for cardiovascular events, such as high blood pressure, diabetes, high cholesterol, or smoking. For these populations, official documents state that use is required to be restricted to the lowest effective dose for the shortest duration.


Q: How quickly does Kretos start working after I begin taking it?

A: Regulatory documents note that the onset of the medicine's effect may be faster when it is administered without food. This is a note for instances when a faster onset of action may be desired.


Q: How long does the effect of one dose of Kretos last?

A: The long elimination half-life of the active ingredient is the pharmacological characteristic that supports the use of a once-daily dosing schedule for continued symptomatic relief.


Q: Is Kretos meant to be taken for a short time or long-term?

A: Official prescribing information states that for acute pain conditions, the medicine should be used only for the short-term symptomatic period. For chronic conditions, the need for continued symptomatic use requires periodic re-evaluation, as noted in the official prescribing information.


Q: Do alcohol and Kretos interact in a concerning way?

A: Regulatory documents do not list a specific interaction between the active ingredient and alcohol in the official drug interaction sections. Regulatory documents typically advise general caution regarding the concurrent use of NSAIDs and alcohol.


Q: Can Kretos affect my ability to drive or operate machinery?

A: Patients who experience side effects such as dizziness, somnolence (sleepiness), or vertigo while taking this medicine are officially cautioned. If these effects occur, official warnings indicate that activities requiring mental alertness should be refrained from.


Q: Are there any warnings about sun exposure while using Kretos?

A: Official adverse event reports include photosensitivity, or an increased sensitivity of the skin to sunlight, among the reported side effects for this medication.


Q: What is the chemical type or class of medicine that Kretos belongs to?

A: Kretos belongs to the broad class of medicines known as Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). More specifically, it is formally classified as a selective Cyclooxygenase-2 (COX-2) inhibitor, sometimes called a coxib.


Q: Is there any research on Kretos's use in children?

A: Official eligibility criteria state that use is contraindicated for children and adolescents under 16 years of age. Although its use is contraindicated, limited clinical research has been conducted to examine the drug’s profile in specific pediatric populations.


Q: Is Kretos known to cause weight changes?

A: General weight gain or loss is not listed as a common reported side effect in official adverse reaction documents. However, fluid retention (oedema) is listed as a common side effect of the medicine.


Q: What are the official cautions or warnings listed for Kretos?

A: Official product information includes special warnings and precautions, particularly regarding potential risks to the cardiovascular system and the gastrointestinal system. These cautions also cover the requirement for careful monitoring of blood pressure during the course of treatment.

How should Kretos be stored and disposed of?

How to Store and Dispose of Kretos (Etoricoxib)

Official regulatory documents define specific environmental and packaging requirements for the storage and disposal of Kretos tablets.

Storage Constraints

Requirement Constraint
Maximum Temperature Do not store above 30 C.
Environmental Protection Must be protected from moisture.
Packaging Rule Store the tablets in the original package.
Child Safety Keep out of the sight and reach of children.

Disposal Instructions

To prevent environmental contamination, unused or expired Kretos must not be thrown away via wastewater or standard household waste. All disposal must follow local regulatory requirements, often requiring the product to be returned to a pharmacist or a designated medicine take-back scheme.

Attention! Always consult to a doctor or pharmacist before using pills or medicines.

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