Parecoxib


Concise Prescribing Info
Indications/Uses
Post-op pain.
Dosage/Direction for Use
Adult : IV/IM 40 mg, then 20 or 40 mg 6-12 hrly. Max: 80 mg/day.
Dosage Details
Parenteral
Postoperative pain
Adult: 40 mg via slow IM or IV inj, then 20 or 40 mg 6-12 hrly as required. Max dose: 80 mg/day.
Elderly: <50 kg: Half the usual dose. Max: 40 mg/day.
Hepatic Impairment
Mild (Child-Pugh score 5-6): No dosage adjustment needed. Moderate (Child-Pugh score 7-9): Half the usual dose. Max: 40 mg/day. Severe (Child-Pugh score ≥10): Contraindicated.
Reconstitution
Reconstitute w/ either NaCl 0.9%, glucose 5%, or NaCl 0.45% w/ glucose 5%.
Incompatibility
Incompatible w/ opioids, glucose in lactated Ringer's soln, sterile water for inj.
Contraindications
Hypersensitivity; history of allergy to sulfonamides; history bronchospasm, acute rhinitis, nasal polyps, angioneurotic oedema, urticaria or allergic-type reactions after taking aspirin, NSAIDs including COX-2 inhibitors. Patient w/ inflammatory bowel disease, CHF (NYHA class II-IV), ischaemic heart disease, peripheral arterial disease, or cerebrovascular disease; treatment of post-op pain following CABG; active peptic ulceration or GI bleeding. Severe hepatic impairment (Child-Pugh score ≥10). Pregnancy (3rd trimester) and lactation.
Special Precautions
Patient w/ risk factor for CV disease (e.g. HTN, DM, hyperlipidaemia), history of cerebrovascular disease and upper GI perforation. Obese or dehydrated patient. Severe renal impairment (CrCl <30 mL/min) and moderate hepatic impairment (Child-Pugh score 7-9). Elderly and childn.
Adverse Reactions
Nausea, pharyngitis, alveolar osteitis (dry socket), anaemia post-op, hypokalaemia, agitation, insomnia, hypoaesthesia, dizziness, HTN, hypotension, resp insufficiency, abdominal pain, vomiting, constipation, dyspepsia, flatulence, pruritus, hyperhidrosis, back pain, oliguria, peripheral oedema, MI, deep-vein thrombosis, pulmonary embolism, stroke, deep surgical infections, sternal wound complications, renal impairment, increased blood creatinine.
Potentially Fatal: Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis.
Patient Counseling Information
May impair ability to drive or operate machinery.
Drug Interactions
May reduce the effect of diuretics and antihypertensives. May increase the nephrotoxic effect of tacrolimus and ciclosporin. May increase risk of bleeding complications w/ warfarin or other anticoagulants. May increase lithium level leading to toxicity.
Action
Description: Parecoxib is the prodrug of valdecoxib. It is a selective cyclo-oxygenase-2 (COX-2) inhibitor primarily responsible to reduce mediators of pain and inflammation. Its action is due to inhibition of prostaglandin synthesis via inhibition of COX-2.
Pharmacokinetics:
Distribution: Plasma protein binding: Approx 98%.
Metabolism: Immediately hydrolysed in the liver to its active metabolite, valdecoxib, and propionic acid.
Excretion: Mainly via urine as inactive metabolites (approx 70%); faeces (trace amounts). Plasma half-life: Approx 22 min.
References
Anon. Parecoxib. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 13/05/2014.

Buckingham R (ed). Parecoxib. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 13/05/2014.

Joint Formulary Committee. Parecoxib. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 13/05/2014.

Preston CL (ed). Interactions of Parecoxib. Stockley’s Drug Interactions [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 13/05/2014.

Disclaimer: This information is independently developed by MIMS based on Parecoxib from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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