Drug Action
Parecoxib is a selective inhibitor of cyclo- oxygenase-2.
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Drug reference
Parecoxib is a selective inhibitor of cyclo- oxygenase-2.
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Short-term management of acute postoperative pain ▶BY DEEP INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS INJECTION ▶Adult: Initially 40 mg, then 20–40 mg every 6–12 hours as required for up to 3 days; maximum 80 mg per day ▶Elderly (body-weight up to 50 kg): Initially 20 mg; maximum 40 mg per day
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Active gastro-intestinal bleeding. active gastro-intestinal ulceration. cerebrovascular disease. following coronary artery bypass graft surgery. inflammatory bowel disease. ischaemic heart disease. mild to severe heart failure. peripheral arterial disease
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Allergic disorders. cardiac impairment (NSAIDs may impair renal function). coagulation defects. connective-tissue disorders. dehydration (risk of renal impairment). elderly (risk of serious side-effects and fatalities). history of cardiac failure. history of gastro- intestinal disorders. hypertension. oedema. risk factors for cardiovascular events
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Contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID—which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID. Contra- indicated in patients with a history of allergic drug reactions including sulfonamide hypersensitivity.
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Scottish Medicines Consortium (SMC) decisions The Scottish Medicines Consortium has advised (January 2003) that parecoxib is not recommended for use within NHS Scotland.
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→Appendix 1: NSAIDs
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▶Common or very common Agitation. back pain. constipation. dizziness. gastrointestinal discomfort. gastrointestinal disorders. hyperhidrosis. hypertension. hypokalaemia. hypotension. increased risk of infection. insomnia. nausea. numbness. peripheral oedema. post procedural complications. renal impairment. respiratory disorders. skin reactions. vomiting ▶Uncommon Appetite decreased. arrhythmias. arthralgia. asthenia. cerebrovascular insufficiency. dry mouth. ear pain. embolism and thrombosis. hyperglycaemia. myocardial infarction. thrombocytopenia ▶Rare or very rare Hypersensitivity. pancreatitis. perioral swelling ▶Frequency not known Angioedema. cardiovascular event. circulatory collapse. congestive heart failure. dyspnoea. fluid retention. hepatitis. renal failure (more common in patients with pre-existing renal impairment). severe cutaneous adverse reactions (SCARs) SIDE-EFFECTS, FURTHER INFORMATION For information about cardiovascular and gastrointestinal side-effects, and a possible exacerbation of symptoms in asthma, see Non- steroidal anti-inflammatory drugs. p. 1193
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Caution—long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment.
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Avoid unless the potential benefit outweighs the risk. Avoid during the third trimester (risk of closure of fetal ductus arteriosus in utero and possibly persistent Anaesthesia pulmonary hypertension of the newborn); onset of labour may be delayed and duration may be increased.
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Avoid—present in milk.
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Manufacturer advises caution in moderate impairment (risk of increased exposure); avoid in severe impairment (no information available). Dose adjustments Manufacturer advises dose reduction to half the usual recommended dose in moderate impairment; maximum 40 mg daily.
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Avoid if possible or use with caution. Dose adjustments The lowest effective dose should be used for the shortest possible duration. Monitoring In renal impairment monitor renal function; sodium and water retention may occur and renal function may deteriorate, possibly leading to renal failure.
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There can be variation in the licensing of different medicines containing the same drug. Powder and solvent for solution for injection ▶Dynastat (Pfizer Ltd) Parecoxib (as Parecoxib sodium) 40 mg Dynastat 40mg powder and solvent for solution for injection vials | 5 vial P £28.34 DT = £28.34 Powder for solution for injection ▶Dynastat (Pfizer Ltd) Parecoxib (as Parecoxib sodium) 40 mg Dynastat 40mg powder for solution for injection vials | 10 vial P £49.60 DT = £49.60 ANALGESICS › OPIOIDS eiiii F 467
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Initially 40 mg, then 20–40 mg every 6–12 hours
First-line fragment. Read the complete Indications and Dose section above.
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