Parecoxib (Dynastat® - Pfizer)
Background
Cautions
Adverse Rxn
Contraindications
Interactions
Links
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
Links/References
Print version Parecoxib preparation
Child-Pugh score EMA (Date of revision: 10/2021). Dynastat 40 mg powder for solution for injection: SPC, Available at: https://www.ema.europa.eu/en/documents/product-information/dynastat-epar-product-information_en.pdf
BNF, (Date of revision of text: 2021). Parecoxib, Parecoxib BNF. https://doi.org/10.18578/BNF.622934498
Glina S., Damiao R., Afif-Abdo, et al., (2011). Efficacy and safety of parecoxib in the treatment of acute renal colic: a randomized clinical trial. International braz j urol: official journal of the Brazillian Society of Urology, 37(6), 697-705. https://doi.org/10.1590/s1677-55382011000600003
Baharuddin, K. A., Rahman, N. H., Wahab, S. F., Halim, N. A., & Ahmad, R. (2014). Intravenous parecoxib sodium as an analgesic alternative to morphine in acute trauma pain in the emergency department. International journal of emergency medicine, 7(1), 2 https://doi.org/10.1186/1865-1380-7-2
Health Products Regulatory Authority (HPRA), (Date of first authorization 08/1992). (Date of revision of text: 12/2022). Diclac 25mg/ml Solution for Injection 3ml Ampoule: SPC. https://www.hpra.ie/img/uploaded/swedocuments/Licence_PA0711-009-010_07122022145820.pdf
Scottish Medicines Consortium (SMC), (Date advice published: 01/2003). Medicines advice: Parecoxib (Dynastat®). https://www.scottishmedicines.org.uk/medicines-advice/parecoxib-dynastat-fullsubmission-2702/
Content by Emma Durand, March 2024. Last review Dr ÍOS 9/07/24.