How Does Parecoxib Work?

Parecoxib is a type of drug called a non-steroidal anti-inflammatory drug (NSAID). It works by stopping the production of compounds called prostaglandins in the body. Prostaglandins have a number of effects on your body, including causing inflammation, which is why it can help to reduce pain and inflammation. It is usually used to relieve pain after surgery.

What type of drug is it?

Parecoxib is a type of drug known as a non-steroidal anti-inflammatory drug (NSAID), which is a group of drugs that all work in a similar way. Other examples of NSAIDs include:

• Aspirin

• Celecoxib

• Diclofenac

• Etoricoxib

• Ibuprofen

• Indomethacin

• Ketoprofen

• Ketorolac

• Mefenamic acid

• Meloxicam

• Naproxen

• Piroxicam

• Sulindac

• Tiaprofenic acid

Parecoxib is a special type of NSAID, which we call a COX-2 selective NSAID. This is because it specifically blocks COX-2 (and not COX-1), which helps to reduce pain and inflammation with a lower risk of side effects. However, when you take higher doses of parecoxib, it also starts to affect COX-1, which is why only low doses are usually used.

What is Parecoxib used for?

Parecoxib is used to help relieve pain after surgery, known as post operative pain. Unlike other other NSAIDS, parecoxib is only available as an injection for use in hospitals or medical clinics.

It is not recommended for long term use because there is an increased risk of serious side effects, such as cardiovascular event.

How does it work?

Parecoxib works by inhibiting COX-2 (and COX-1 at higher doses), which is needed to produce some types of prostaglandins in your body.

You have many different types of prostaglandins in your body, with some in almost every tissue. They each have different effects on your body, such as to cause your blood vessels to relax and widen, the platelets in your blood to come together to form a clot, or the tissues in your body to become inflamed.

Unlike other general NSAIDs that block both COX-1 and COX-2, parecoxib usually only blocks the action of COX-2. Inflammation is mostly caused by the prostaglandins that produced with the help of COX-2. Therefore, parecoxib has a more targeted effect to reduce pain and inflammation, with fewer side effects from the COX-1 related prostaglandins, such as blood clotting and hypertension.

Side Effects

Even though Parecoxib has a more targeted effect than other NSAIDs because it only affects COX-2, you may still experience some side effects. These may include:

• Nausea​

• Heartburn (dyspepsia)

• Diarrhea

• Headache

• Dizziness

This is not a complete list of side effects, but just some of the most common. Please see the Parecoxib information leaflet for more detailed information.

Drug Interactions

Parecoxib can interact with many other medications when they are used in together, including:

• ACE Inhibitors

• Aldosterone antagonists

• Alendronate

• Amiloride

• Aspirin

• Beta blockers

• Brimonidine

• Calcineurin inhibitors

• Corticosteroids

• Cyclosporin

• Fluconazole

• Lithium

• Loop diuretics

• Methotrexate

• Phenindione

• Potassium

• Prostaglandin analogues

• Rifampicin

• Sartans

• Tacrolimus

• Thiazide diuretics

• Thiazolidinediones

• Triamterene

• Warfarin

These medications can often be used together, but your doctor should be aware that you are taking both medications so that they can adjust the dose as needed to ensure they are safe and effective.

Cautions

There are some people who may need to avoid using Parecoxib, or use it with caution, because they may be at risk of side effects due to the medication.

Peptic ulcers or GI bleeding:

Parecoxib is not often used for people who have a history of gastrointestinal bleeding or peptic ulcers. While it is less likely than other NSAIDs to cause peptic ulcers or gastrointestinal bleeding, they can still occur. If it is used, a combination with a medication to help prevent gastrointestinal problems, such as esomeprazole or pantoprazole, is recommended.

Coagulation disorders:

Parecoxib may increase the risk of bleeding or thrombosis because the antiplatelet effect of the prostaglandins may be reduced. This is less likely with parecoxib than other NSAIDS, although it can still occur.

Cardiovascular disease:

Parecoxib should not be used if you have heart failure, angina, peripheral artery disease or cerebrovascular disease. It may also cause retention of sodium and fluid in the body, which can make hypertension and heart failure worse.

Asthma:

Parecoxib may increase the risk of bronchospasm and cause symptoms of asthma to worsen. Some people with asthma can use them without any problems, but it is best to use a low dose and watch for signs of worsening asthma if you are using it for the first time.

Inflammatory Bowel Disease (IBD):

Parecoxib may cause symptoms of inflammatory bowel disease to get worse.

Renal Impairment

Parecoxib can cause renal impairment is some people, particularly when used in combination with some other medications. If you already have some renal impairment, an NSAID may not be the best choice for you.

Pregnancy and Breastfeeding

Parecoxib is not usually recommended for women who are pregnant or trying to conceive. This is because it can interfere with fertility and the development of the fetus.

For women planning to become pregnant, it can prevent or delay ovulation, so that the woman is less likely to conceive. Additionally, using parecoxib during pregnancy, particularly at the time of conception, is linked to a higher risk of miscarriage. It may also cause other problems later on in the pregnancy and should be avoided.

For women who are breastfeeding, parecoxib is considered safe to use.

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