Generic
Parecoxib
2 brands available in the market
At a glance
Parecoxib is a prodrug that is converted to valdecoxib, a selective COX-2 inhibitor. It is used for the short-term treatment of postoperative pain in adults.
Description
Parecoxib is a prodrug of valdecoxib. Valdecoxib is a selective COX-2 inhibitor within the clinical dose range. Cyclooxygenase is responsible for generation of prostaglandins. COX-2 is the isoform of the enzyme that has been shown to be induced by pro-inflammatory stimuli and has been postulated to be primarily responsible for the synthesis of prostanoid mediators of pain, inflammation, and fever.
Indications
- Postoperative pain (short-term)
- Post-dental extraction pain
- Post-orthopedic surgery pain
- Post-gynecologic surgery pain
Therapeutic class
Non-steroidal Anti-inflammatory Drugs
Pharmacological class
COX-2 Inhibitor
Pharmacology
Parecoxib is a prodrug of valdecoxib. Valdecoxib is a selective COX-2 inhibitor that inhibits prostaglandin synthesis. COX-2 is the isoform of the enzyme induced by pro-inflammatory stimuli and is primarily responsible for the synthesis of prostanoid mediators of pain, inflammation, and fever.
Mechanism of action
Selectively inhibits COX-2 enzyme to inhibit prostaglandin synthesis, relieving pain and inflammation.
Dosage
Adult Dose (IV/IM):
- Recommended dose: 40 mg IV or IM, followed by 20-40 mg every 6-12 hours as needed; max 80 mg/day
- Limited clinical experience beyond 3 days of treatment
- Elderly (≥65 years): Generally no dose adjustment needed; however, for elderly <50 kg, initiate with half the usual dose and reduce max daily dose to 40 mg
Pediatric Dose: Safety and efficacy not established in children under 18 years; not recommended.
Administration
- IV bolus may be given rapidly directly into a vein or into an existing IV line
- IM injection should be given slowly and deeply into the muscle
- Do not mix with other medicinal products; if using same IV line, flush before and after with compatible solution
- Follow reconstitution instructions
Missed dose
If you miss a dose, take it as soon as you remember; skip if it's almost time for next dose; do not double the dose.
Side effects
Common Side Effects:
- Blood pressure changes (increase or decrease)
- Back pain
- Swelling of ankles, legs, and feet (fluid retention)
- Numbness (loss of sensitivity to pain and touch)
- Vomiting, abdominal pain, indigestion, constipation, bloating, and gas
- Abnormal kidney function tests
- Agitation or difficulty sleeping
- Dizziness
- Anemia (changes in red blood cells post-surgery)
- Sore throat or difficulty breathing
- Itchy skin
- Decreased urine output
- Dry socket (inflammation and pain after tooth extraction)
- Increased sweating
- Low blood potassium levels
Precautions & warnings
- Potential for increased adverse reactions at higher doses compared to other COX-2 inhibitors and NSAIDs; monitor patients after dose increase
- Limited clinical experience beyond 3 days
- Studied in dental, orthopedic, gynecologic, and CABG surgery; limited experience in other surgeries
- Other administration routes (e.g., intra-articular, intrathecal) have not been studied
- If organ system deterioration occurs, consider discontinuation
Contraindications
- Hypersensitivity to parecoxib or any of its components
- Third trimester of pregnancy
Drug interactions
- Do not mix in solution with other medicinal products (precipitation may occur)
- If using same IV line for other drugs, flush before and after
Food interactions
Take with food for better absorption.
Use in pregnancy
Use in Pregnancy: Suspected to cause serious birth defects in the last trimester; may cause premature closure of the ductus arteriosus or uterine inertia. Second and third trimester use may cause fetal renal dysfunction. Contraindicated in the third trimester.
Pregnancy Category: D — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Single dose after cesarean section transfers small amounts of parecoxib and valdecoxib into breast milk; infant relative dose approximately 1%. Must not be administered to breastfeeding women.
Pediatric use
Safety and efficacy not established in children under 18 years; not recommended.
Geriatric use
Elderly patients (≥65 years) generally do not require dose adjustment; however, for those weighing <50 kg, initiate with half the usual dose and max 40 mg/day.
Renal / hepatic impairment
Renal Impairment: Caution in kidney disease; dose adjustment may be needed.
Hepatic Impairment: Caution in liver disease; dose adjustment may be needed.
Overdose effects
Overdose symptoms are similar to adverse reactions seen with recommended doses. Treatment: symptomatic and supportive care. Valdecoxib is not removed by hemodialysis; diuresis or urine alkalinization may not be useful due to high protein binding.
Storage conditions
Store below 30°C in a dry place, protected from light and moisture; keep out of reach of children.
Chemical structure
Parecoxib