EMed

Parecoxib (Dynastat® - Pfizer)

Parecoxib (Dynastat® Pfizer)

  • Selective cyclooxygenase-2 (COX-2) inhibitor
  • Short term Mx acute pain, esp. ureteric & MSK trauma
  • 40mg IV then by 20mg or 40mg every 6–12 hours PRN
  • May be co-administered with opiates
  • Max: daily dose = 80mg/day, duration = 3 days
  • More expensive but easier to prepare than IV diclofenac

Cautions

Elderly

  • No dose adjustment is generally necessary in patients (≥65 years)
  • In elderly < 50kg, max dose is 20mg (Max:40mg/day)

Renal Impairment

  • Severe renal impair. → use lowest dose (20mg) & monitor kidney fxn

Hepatic Impairment:

  • Child-Pugh B: use lowest recommended dose
  • Child-Pugh Class C: not recommended

Adverse Rxns

  • Nausea commonest
  • Rarely: AMI/ACS, & ⇓BP
  • Hypersensitivity event
  • More on the SPC

Contraindications

  • Hypersensitivity Rxn to active substance (see SPC)
  • Active peptic ulceration or GI bleeding
  • Hx serious Rxn to sulfonamides (incl. SJS and DRESS)
  • Hx Rxn to Aspirin or NSAIDs/COX-2 inhibitors
  • Third trimester of pregnancy and breast-feeding
  • Severe hepatic impairment (Child Pugh ≥10)
  • Inflammatory bowel disease
  • Congestive heart failure (NYHA II – IV)
  • Treatment post-op pain following CABG surgery
  • Established IHD, PVD &/or cerebrovascular disease

Drug interactions

  • Warfarin and other anticoagulants
  • ACEi, Angiotensin-II antags., Β-blockers, diuretics
  • Ciclosporin and tacrolimus
  • Fluconazole and ketoconazole
  • CYP2D6 substrates (e.g. Dextromethorphan, flecainide, propafenone, metoprolol)
  • CYP2C19 substrates (e.g. Omeprazole, phenytoin, diazepam, imipramine)
  • Methotrexate
  • Lithium
  • More on the SPC

Content by Emma Durand, March 2024. Last review Dr ÍOS 4/04/24.