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Parecoxib parenteral


Injections of parecoxib.

Drugs List

  • DYNASTAT 40mg powder for solution for injection
  • parecoxib 40mg powder for solution for injection
  • Therapeutic Indications


    Treatment of post-operative pain


    The decision to prescribe parecoxib should be based on an assessment of the individual patient's overall risk.

    Patients should be reviewed after each dose increase, as higher dose parecoxib use can increase adverse reactions. Other therapeutic options should be considered if increased efficacy is absent.

    There is limited experience with parecoxib treatment beyond 3 days.


    40mg followed every 6 to 12 hours by 20mg or 40mg as required for up to 3 days (maximum daily dose 80mg).


    Patients 65 years and over weighing less than 50kg, treatment should be initiated at 20mg (maximum daily dose 40mg).

    Patients with Renal Impairment

    Creatinine clearance 10 to 30ml/minute: Initiate dose at 20mg and monitor renal function closely.

    Patients with Hepatic Impairment

    Moderate hepatic impairment (Child-Pugh score 7 to 9): Initiate dose at 20mg (maximum daily dose 40mg).

    Additional Dosage Information

    Patients with predisposition to fluid retention: Initiate dose at 20mg and monitor renal function closely.


    The dose may be administered intravenously or intramuscularly after reconstitution.

    The intramuscular injection should be given slowly and deeply into the muscle.

    The intravenous bolus injection may be given rapidly and directly into a vein or into an existing intravenous line. If other drugs are delivered through the same IV line, the line must be flushed before and after parecoxib injection with a compatible fluid.


    Children under 18 years
    Coronary artery bypass graft
    Asthma, urticaria or acute rhinitis associated with NSAIDS
    Cerebrovascular disorder
    Congestive cardiac failure
    Gastrointestinal haemorrhage
    History of severe cutaneous adverse reactions
    Inflammatory bowel disease
    Ischaemic heart disease
    Nasal polyps, angioedema, and bronchospastic reactivity to NSAIDs
    Peptic ulcer
    Peripheral vascular disease
    Severe hepatic impairment
    Third trimester of pregnancy

    Precautions and Warnings

    Elderly patients weighing less than 50kg
    Females attempting to conceive
    Predisposition to fluid retention
    Risk factors for cardiovascular disorder
    Cardiac disorder
    Connective tissue disorder
    First trimester of pregnancy
    History of cardiac failure
    History of gastrointestinal bleeding
    History of gastrointestinal perforation
    History of gastrointestinal ulceration
    Moderate hepatic impairment
    Renal impairment
    Second trimester of pregnancy

    May mask fever
    May mask signs of inflammation
    Advise ability to drive/operate machinery may be affected by side effects
    Correct severe dehydration before commencing therapy
    Monitor blood pressure
    Monitor incision site for signs of infection in surgical patients
    Discontinue if any deterioration in cardiac status occurs
    Risk of gastro-intestinal bleeding increased in the elderly
    Discontinue if hepatic function deteriorates
    Discontinue if hypersensitivity reactions occur
    Discontinue if patient is attempting to conceive
    Discontinue if renal function deteriorates
    Discontinue treatment if rash occurs
    Continue concurrent antiplatelet therapies eg aspirin
    Reduce dose in elderly patients weighing less than 50kg
    Use the lowest dose resulting in effective analgesia
    Maximum treatment 3 days
    Advise patients to report skin rash

    Pregnancy and Lactation


    Parecoxib is contraindicated during the 3rd trimester of pregnancy. Use with caution during the 1st and 2nd trimester.

    Use of parecoxib during the 3rd trimester of pregnancy is contraindicated by the manufacturer. The manufacturer does not recommend using parecoxib during the 1st and 2nd trimester of pregnancy. At the time of writing there is limited published information regarding the use of parecoxib during pregnancy and labour. However, the effects of NSAIDs in pregnancy pose a potential risk that cannot be ruled out. The risks include serious birth defects when parecoxib is administered during the 3rd trimester of pregnancy. This is due to the nature of NSAIDs as a prostaglandin synthesis inhibitor where premature closure of the ductus arteriosus or uterine inertia may be caused. Animal studies have shown an increased in pre- and post-implantation loss and embryo-foetal lethality. Available data indicates that the risk of miscarriage increases in early pregnancy after the use of prostaglandin synthesis inhibitors. Therefore, avoid using parecoxib during the 1st and 2nd trimester unless deemed necessary. If NSAIDs are used, monitoring of amniotic fluid volume is recommended.


    Parecoxib is contraindicated during breastfeeding.

    Use of parecoxib when breastfeeding is contraindicated by the manufacturer. Parecoxib and its active metabolite valdecoxib is present in human breast milk in a relatively small amount at approximately 1% of the weight-adjusted maternal dose. Effects on exposed infants are unknown.

    Side Effects

    Abnormal sternal serous wound drainage
    Acute renal failure
    Aggravation of existing hypertension
    Alveolar osteitis
    Back pain
    Cardiovascular effects
    Cerebrovascular disorders
    Circulatory collapse
    Congestive cardiac failure
    Creatine phosphokinase increased
    Deep vein thrombosis (DVT)
    Dry mouth
    Ear pain
    Erythema multiforme
    Exfoliative dermatitis
    Fluid retention
    Gastro-intestinal disturbances
    Hypersensitivity reactions
    Increase in blood urea nitrogen
    Increase in lactate dehydrogenase
    Increase in serum ALT/AST
    Injection site reactions
    Local pain (injection site)
    Mouth swelling
    Myocardial infarction
    Orthostatic hypotension
    Peripheral oedema
    Postoperative anaemia
    Pulmonary embolism
    Renal failure
    Renal impairment
    Respiratory insufficiency
    Serum creatinine increased
    Skin reactions
    Stevens-Johnson syndrome
    Thromboembolic complications
    Toxic epidermal necrolysis
    Transient ischaemic attack
    Wound healing retarded
    Wound infection


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: October 2021

    Reference Sources

    Summary of Product Characteristics: Dynastat 40mg Powder and Solvent for Solution for Injection. Pfizer. Revised October 2020.

    NICE Evidence Services Available at: Last accessed: 25 October 2021

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    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

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    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.