I am using parecoxib a lot since they tell me its the best thing since sliced bread.
But I am yet to be conviced that its as good as the old fashioned NSAIDS that we gave as suppositories.
I know we are supposed to wait 90 minutes for tis epak effect, even with IV administration, but I just getthe impression that patients were more confortable with my old regimen.
Anyone care to agree or argue?
I likewise am using parecoxib. We often do not see our patients 1-2 hours post-op and this is the time-period that parecoxib takes to start working. When you do follow-up these patients, they do seem to be very comfortable, comparable to other NSAIDs.
My concern is that now that Vioxx has been withdrawn from the market, and Celebrex has also had a cloud cast a shadow, will they make a knee-jerk reaction and withdraw all COx-2 inhibitors from the market. Parecosib is given as a single perioperative dose and should not affect cardiac risk, unlike the prolonged use of the other COx-2 inhibitors.
I am using parecosib routinely for anything but the most minor surgery, and avoiding asthmatics and renal disease patients. I find that it is extremely effective, with markedly decreased narcotic requirements when given early enough.
Two points need to be made:
- It works at the site of injury, so it is useless giving it while a torniquet is in situ. Wait for the torniquet to be released, and then the limb becomes relatively hyperemic and more of the active drug gets to the site of injury. ALternatively, give it well before the torniquet is inflated.
- Be very careful in patients with a history of sulfur allergy. Valdecoxib, the active metabolite of parecoxib has a tricyclic structure and a sulfur element. See this warning (http://www.emea.eu.int/pdfs/human/press/pus/2517502en.pdf) (its a pdf file).