Parecoxib: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
Parecoxib: clinical details
Prescribing considerations
- Assess cardiovascular, gastrointestinal, renal, hepatic, allergy and fluid-retention risks.
- Avoid concurrent non-aspirin NSAIDs and correct dehydration before treatment.
- Use caution with hypertension, impaired kidney function, moderate hepatic impairment, oedema or major cardiovascular risk factors.
- Parecoxib may mask fever or other inflammatory signs; monitor surgical wounds for infection.
- Safety and efficacy are not established in people under 18 years.
Contraindications and cautions
- Hypersensitivity to parecoxib, excipients or sulfonamides; previous serious allergic or severe cutaneous drug reaction
- Active peptic ulceration or gastrointestinal bleeding
- Previous asthma, angioedema, urticaria, rhinitis or similar reaction caused by aspirin or another NSAID
- Third trimester of pregnancy or breastfeeding
- Severe hepatic impairment
- Inflammatory bowel disease
- NYHA class II–IV congestive heart failure
- Established ischaemic heart disease, peripheral arterial disease or cerebrovascular disease
- Postoperative pain following coronary artery bypass graft surgery
Monitoring
- Blood pressure and cardiovascular status
- Renal function, hydration, urine output and fluid retention in at-risk patients
- Gastrointestinal bleeding or ulcer symptoms
- Skin, mucosal and hypersensitivity reactions
- Appropriate anticoagulation parameters when used with anticoagulants
- Lithium concentrations or methotrexate toxicity where applicable
- Surgical wound and infection signs
Clinical pharmacology
Parecoxib is rapidly hydrolysed, mainly in the liver, to active valdecoxib. Valdecoxib metabolism involves CYP3A4 and CYP2C9, and it can inhibit CYP2D6 and CYP2C19.
Formulation and product differences
- The selected product is a preservative-free powder requiring aseptic reconstitution.
- Compatible fluids include specified sodium chloride, glucose, or combined sodium chloride and glucose solutions.
- Ringer-Lactate may be compatible as a running intravenous fluid but should not reconstitute the powder because precipitation may occur.
- The solution is for intravenous or intramuscular use only and is single-use.
Parecoxib preparations and strengths
Injection
Route: Parenteral
Strengths: 40 mg
Parecoxib interactions
The clinical team should review all prescribed, over-the-counter and complementary products before administration.
Warfarin and other oral anticoagulants
Bleeding risk increases; anticoagulation, including INR where relevant, requires close monitoring.
Aspirin, other NSAIDs, antiplatelets, corticosteroids or SSRIs
Gastrointestinal ulceration or bleeding risk may increase; concurrent non-aspirin NSAIDs should be avoided.
ACE inhibitors, angiotensin-II receptor blockers, beta-blockers and diuretics
Their effects may be reduced, with greater risk of kidney deterioration in susceptible patients.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.