parecoxib sodium: clinical use

Prescribing considerations

• Assess cardiovascular, gastrointestinal, renal, hepatic, allergy and fluid-retention risks.
• Correct dehydration before administration where possible.
• Avoid concurrent non-aspirin NSAIDs.
• Parecoxib may mask fever or other inflammatory signs; continue surveillance for postoperative infection.

Contraindications and cautions

• Hypersensitivity to parecoxib, excipients or sulfonamides, or a history of serious allergic drug reactions
• Active peptic ulceration or gastrointestinal bleeding
• Previous bronchospasm, rhinitis, nasal polyps, angioedema or urticaria after aspirin or another NSAID
• Established ischaemic heart disease, peripheral arterial disease or cerebrovascular disease
• Congestive heart failure classified as NYHA II–IV
• Pain following coronary artery bypass graft surgery
• Severe hepatic impairment
• Inflammatory bowel disease
• Third trimester of pregnancy or breastfeeding

Monitoring

• Blood pressure
• Renal function, urine output, hydration and fluid retention
• Signs of gastrointestinal bleeding or ulceration
• New rash, mucosal lesions or hypersensitivity
• Surgical wounds and other signs of infection
• Anticoagulation parameters when used with oral anticoagulants
• Lithium concentration or methotrexate toxicity where relevant

Clinical pharmacology

Parecoxib is rapidly hydrolysed to valdecoxib, a selective COX-2 inhibitor. Valdecoxib undergoes hepatic metabolism involving CYP3A4, CYP2C9 and glucuronidation.

Formulation and product differences

• Both selected products contain sterile powder requiring reconstitution before intravenous or intramuscular use.
• The powder-and-solvent presentation includes a sodium chloride solvent ampoule; the powder-only presentation requires a separately supplied compatible reconstitution solution.
• The reconstituted solution is preservative-free and intended for single use.

Injection

Route: Parenteral

Strengths: 40 mg