parecoxib

Introduction

an injectable pro-drug form of the COX2 selective inhibitor, valdecoxib.
the first parenteral COX-2 selective inhibitor available for clinical use in pain management
onset of action after IM / IV dose is 7-13 minutes with analgesia commencing 23-39 minutes and peaking at under 2 hours
duration of analgesia after a single dose is 6-12 hours and gives longer duration analgesia than ketorolac
elimination half life of valdecoxib is 8hrs and 70% is excreted in kidneys. Metabolism includes cytochrome P450 3A4 and 2C9, so there is a potential for interaction with drugs which inhibit or induce these enzymes.
has only been approved for use as a single perioperative injection so most of the safety data refer to single doses
may increase incidence of heart attacks after heart surgery and rarely can cause SJS although a 2017 pooled analysis of safety data in 28 published studies, which showed after 69,567,300 units of parecoxib, skin rash and cardiac complications were minimal, if at all, different from placebo.

known HS to parecoxib sodium or valdecoxib
patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin, NSAID’s or other COX-2 specific inhibitors
peptic ulcer risk (although lower risk than ketorolac or non-steroidal anti-inflammatory drugs (NSAIDs)
significant dehydration
severe liver disease
pregnancy (Cat C)
post-op cardiac surgery

do not reconstitute with water for injection as it may precipitate, use 0.9% saline or 5% dextrose instead