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Parecoxib information from DrugsUpdate  

See Available Brands of Parecoxib in India

P - Contraindicated in pregnancy
L - Contraindicated in lactation

Parecoxib is a water soluble and injectable prodrug of valdecoxib. It is marketed as Dynastat in the European Union. Parecoxib is a COX2 selective inhibitor in the same category as celecoxib (Celebrex) and rofecoxib (Vioxx).

Pharmacodynamics

Pharmacokinetics

Parecoxib is the prodrug of valdecoxib. It has a very high selectivity for inhibiting cyclo-oxygenase-2 (COX-2) mediated prostaglandin synthesis to reduce mediators of pain and inflammation. The selective inhibition of COX-2 is coupled with reduced GI toxicity, but associated increased risk for thrombotic events and renal impairment have been noted.

Distribution
Plasma protein binding: approx 98%.

Metabolism
Hydrolysed in the liver to its active metabolite, valdecoxib, and propionic acid; plasma half-life: 22 minutes.

Excretion
Via urine; approx 70% of a dose appearing as inactive metabolites, <5% of a dose appears as unchanged valdecoxib in the urine. Trace amounts of unchanged drug in faeces. Elimination half-life: 8 hours.

Parecoxib Indications / Parecoxib Uses

Information Not Available

Parecoxib Adverse Reactions / Parecoxib Side Effects

Rash, ulcerations or any other signs of an allergic reaction; GI disturbances and bleeding; hypotension; hypertension; back pain; oedema; numbness; agitation or sleeping difficulties; anaemia; sore throat or difficulty breathing; pruritus; decreased urine output; jaundice, abnormal liver function; low platelet count; skin swelling, blistering or peeling; kidney failure; heart failure, heart attack, bradycardia, arrhythmia.

Potentially Fatal: Anaphylaxis, Steven-Johnson syndrome, toxic epidermal necrolysis.

Precautions

Information Not Available

Special Precautions

Elderly, children ; history of GI ulceration, perforation or bleed; oedema; dehydration; hyperlipidaemia; DM; hypertension; liver or kidney disease; concurrent infection. May impair ability to drive or operate machinery.

Other Drug Interactions

Enhances effects of oral anticoagulants (azapropazone and phenylbutazone); increases plasma concentrations of lithium, methotrexate, and cardiac glycosides; increased risk of nephrotoxicity with ACE inhibitors, ciclosporin, tacrolimus, or diuretics; reduces antihypertensive effects of some antihypertensives (ACE inhibitors, beta blockers, diuretics); occurrence of convulsions with quinolones; increases effects of phenytoin and sulfonylurea antidiabetics; increased risk of adverse effects with other NSAIDs (including aspirin) and misoprostol; risk of GI bleeding and ulceration increased with corticosteroids, SSRIs, the SNRI venlafaxine, the antiplatelets clopidogrel and ticlopidine, iloprost, erlotinib, sibutramine, alcohol, bisphosphonates, or pentoxifylline; increased risk of haematotoxicity with zidovudine; increased plasma concentrations with ritonavir; may alter the efficacy of mifepristone; metabolism may be decreased with CYP3A4 (e.g ketoconazole) and CYP2C9 inhibitors (e.g. fluconazole), or increased with enzyme inducers (e.g. carbamazepine, dexamethasone).

Other Interactions

Information Not Available

Dosage

Parenteral
Postoperative pain
Adult: 40 mg slow IM or IV injection, then 20 or 40 mg every 6-12 hours as required. Max dose: 80 mg/day.
Child: <18 years: Not recommended.
Elderly: <50 kg: 20 mg slow IV or IM injection, repeat to a max of 40 mg/day.
Hepatic impairment: Mild impairment (Child-Pugh score 5-6): No dosage adjustment. Moderate impairment (Child-Pugh score 7-9): Half the usual dose, repeat to a max of 40 mg/day. Severe impairment (Child-Pugh score >9): Not recommended.

Reconstitution
Reconstitute with sodium chloride 0.9%, glucose 5%, or sodium chloride 0.45% with glucose 5%.

Food(before/after)

Information Not Available

List of Contraindications

Parecoxib and Pregnancy

Contraindicated in pregnancy

Parecoxib and Lactation

Contraindicated in lactation

Parecoxib and Children

Information Not Available

Parecoxib and Geriatic

Information Not Available

Parecoxib and Other Contraindications

Aspirin or NSAID hypersensitivity; allergy to sulphonamides; inflammatory bowel disease; moderate to severe heart failure; ischaemic heart disease, peripheral arterial disease, or cerebrovascular disease; following CABG; active peptic ulceration; severe hepatic impairment (Child-Pugh score ≥10); pregnancy (3rd trimester) and lactation.

Storage

Information Not Available

Lab interference

Information Not Available

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