COX-2 Selective NSAID (Parenteral) Pregnancy: Avoid — third trimester absolute contraindication

Parecoxib

Brand names: Dynastat

Adult dose

Dose: 40 mg IV/IM loading, then 20–40 mg every 6–12h. Maximum duration: 3 days IV/IM, then switch to oral COX-2 inhibitor or other NSAID.

Route: IV slow injection or IM

Frequency: Every 6–12h

Max: 80 mg/day; 3-day IV/IM limit

For post-operative pain. COX-2 selective — lower GI side effects than non-selective NSAIDs. NOT for patients with cardiovascular disease or renal impairment. Prodrug of valdecoxib (active).

Paediatric dose

Route: N/A

Frequency: N/A

Max: Not licensed in children

No established paediatric dosing

Dose adjustments

Renal

Avoid in renal impairment (eGFR <30)

Hepatic

Reduce dose in moderate hepatic impairment; avoid in severe

Clinical pearls

IV/IM route allows analgesia when oral route not available — useful perioperatively
COX-2 selectivity: less GI bleeding risk than non-selective NSAIDs; however cardiovascular risk is NOT reduced vs non-selective NSAIDs
Maximum 3-day IV/IM course — longer use increases cardiovascular risk
Multimodal analgesia: parecoxib + paracetamol + low-dose opioid reduces opioid requirements significantly post-operatively

Contraindications

Ischaemic heart disease/stroke/peripheral arterial disease
Moderate-severe CHF
Renal impairment
Sulfonamide allergy
Active GI ulcer/bleed
Post-CABG surgery (first 14 days)

Side effects

Cardiovascular events (COX-2 selective NSAIDs increase MI/stroke risk)
GI events (less than non-selective NSAIDs)
Hypertension
Peripheral oedema
Dizziness

Interactions

Anticoagulants — increased bleeding risk
ACEi/ARBs — renal impairment risk
Lithium — increased lithium levels

Monitoring

Blood pressure and cardiovascular symptoms
Renal function
GI symptoms
Wound healing

Reference: BNFc; BNF; NICE Analgesics Review; Dynastat SPC. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Pathways