Formulary
Parecoxib: Indications, Dosing, Side Effects and Interactions
Parecoxib is a selective inhibitor of cyclo-oxygenase-2.
MedNext Academy | 3 min read
Parecoxib: Indications, Dosing, Side Effects and Interactions
Parecoxib is a selective inhibitor of cyclo-oxygenase-2.
Drug action
Parecoxib is a selective inhibitor of cyclo-oxygenase-2.
Indications and dose
**Short-term management of acute postoperative pain**
- **Adult** (By Deep Intramuscular Injection, Or By Intravenous Injection): Initially 40 mg, then 20-40 mg every 6-12 hours as required for up to 3 days; maximum 80 mg per day.
- **Elderly** (By Deep Intramuscular Injection, Or By Intravenous Injection): (body-weight up to 50 kg) Initially 20 mg; maximum 40 mg per day.
Cautions
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; may mask symptoms of infection; oedema; risk factors for cardiovascular events
Contraindications
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
Side effects
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.
Interactions
**Severe interactions:**
- In clinical trials, the daily requirement for PRN opioids was significantly reduced when co-administered with parecoxib.
- Co-administration of valdecoxib and lithium produced significant decreases in lithium serum clearance (25%) and renal clearance (30%) with a 34% higher serum exposure compared to lithium alone.
- Additionally, co-administration of valdecoxib had no clinically significant effect on the hepatic or intestinal CYP 3A4-mediated metabolism of orally administered midazolam.
- Administration of IV parecoxib 40 mg had no significant effect on the pharmacokinetics of either IV fentanyl or IV alfentanil (CYP3A4 substrates).
**Other interactions (22):**
- Pharmacodynamic interactions Anticoagulant therapy should be monitored, particularly during the first few days after initiating parecoxib therapy in patients receiving warfarin or other...
- Therefore, patients receiving oral anticoagulants should be closely monitored for their prothrombin time INR, particularly in the first few days when therapy with parecoxib is initiated or the dose...
- In the submitted studies, as with other NSAIDs, an increased risk of gastrointestinal ulceration or other gastrointestinal complications compared to use of parecoxib alone was shown for concomitant...
- Co-administration of parecoxib and heparin did not affect the pharmacodynamics of heparin (activated partial thromboplastin time) compared to heparin alone.
- Inhibition of prostaglandins by NSAIDs, including COX-2 inhibitors, may diminish the effect of angiotensin converting enzyme (ACE) inhibitors, angiotensin II antagonists, beta-blockers and diuretics.
- This interaction should be given consideration in patients receiving parecoxib concomitantly with ACE-inhibitors, angiotensin II antagonists, beta-blockers and diuretics.
Pregnancy
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 pulmonary hypertension of the newborn); onset of labour may be delayed and duration may be increased.
Breast feeding
Avoid-present in milk.
Hepatic impairment
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.
Renal impairment
In general, for NSAIDs the MHRA advises to avoid where possible; if necessary, use with caution (risk of fluid retention and further renal impairment, including renal failure). Dose adjustments Reduce initial dose to 20 mg if creatinine clearance less than 30 mL/minute. M See Prescribing in renal impairment .
Medicinal forms
Solution,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
Inside MedNext for this topic
- 411 MedNext-authored chapters
- 80,000+ MCQ bank
- 15 study modes
- Growing visual cheat sheets
Study modes
- Notes
- MCQ
- Audio
- Video
- Visual
- 3D Anatomy
- Trace
- Flashcards
- Mnemonics
- Image Bank
- Clinical
- Microscopy
- Audio QBank
- Cadaver
- Book Match
Continue reading
Subject HubPharmacology Hub
All pharmacology resources in one place.
Drug SchedulesIndian Drug Schedules
Schedule H, H1, X and G classifications.
FormularyBrowse all drugs
Search 1,850+ drug profiles.
Study Parecoxib in the MedNext app
Challenge yourself with targeted pharmacology MCQs on this drug class. Every explanation links back to the chapter that teaches the concept.
Start drug challengeExplore the full formulary

