Parecoxib

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Definition
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Selective cyclooxygenase inhibitor (COX-2 inhibitor), which is considered a perioperative alternative to mixed NSAIDs (e.g. diclofenac or others). Parecoxib has no ulcerogenic effect and does not inhibit platelet aggregation.

Indication
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For short-term treatment of post-operative pain.

Pregnancy/nursing period
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Contraindicated in the 3rd trimester (risk of weakness in labour and premature closure of the Botalli duct). Strictest examination of the indication in the 1st and 2nd trimester (insufficient data, no adequate and well-controlled studies available!) Do not use in the lactation period!

Dosage and method of use
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Initial 40 mg i.v. or i.m., add 20 mg or 40 mg i.v. or i.m. every 6-12 hours as required. Maximum daily dose: 80 mg.

Notice! Dose adjustment necessary in older patients (≥ 65 yrs.), especially with a weight < 50 kg KG and with liver dysfunction!

Undesirable effects
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Among others, hypertension, hypotension, back pain, peripheral edema, hypaesthesia, alveolar osteitis, dyspepsia, flatulence, creatinine increase, hypokalemia, agitation, insomnia, pharyngitis, pruritus, oliguria.

Interactions
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Oral anticoagulants (phenprocoumon, warfarin): Increased risk of bleeding. Reduced effectiveness of diuretics and antihypertensives. ACE inhibitors/diuretics: Risk of acute renal failure. Ciclosporin A and Tacrolimus: increase in nephrotoxic effects of Ciclosporin and Tacrolimus.

Contraindication
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Cave!

Sulfamide allergy! Adverse drug reaction after ingestion of acetylsalicylic acid, COX-2 inhibitors or other NSAIDs, active peptic ulcers, gastrointestinal bleeding, inflammatory bowel disease, severe decompensated heart failure, severe liver dysfunction.

Notice! Do not use on children!

Preparations
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Dynasty

Literature
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  1. Capone ML et al (2003) Clinical pharmacology of selective COX-2 inhibitors. Int J Immunopathol Pharmacol 16(2 Suppl): 49-58
  2. Joshi GP et al (2004) Effective treatment of laparoscopic cholecystectomy pain with intravenous followed by oral COX-2 specific inhibitor. Anesth Analg 98: 336-342
  3. Malan TP Jr et al (2003) Parecoxib sodium, a parenteral cyclooxygenase 2 selective inhibitor, improves morphine analgesia and is opioid-sparing following total hip arthroplasty. Anesthesiology 98: 950-956
  4. Mehlisch DR et al (2003) Single doses of parecoxib sodium intravenously are as effective as ketorolac in reducing pain after oral surgery. J Oral Maxillofac Surgery 61: 1030-1037
  5. Smith HS et al (2003) Meloxicam and selective COX-2 inhibitors in the management of pain in the palliative care population. At J Hosp Palliat Care 20: 297-306

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Last updated on: 29.10.2020