Parecoxib Fentanyl

I. ANALGESICS - parecoxib, fentanyl, methadone, tramadol 2. ANTIBIOTICS - doxycycline, telithromycin... 

Ibrahim AE, Feldman J, Karim A, Kharasch ED. Simultaneous assessment of drug interactions with low- and high-extraction opioids. Application to parecoxib effects on the pharmacokinetics and pharmacodynamics of fentanyl and alfentanil. Anesthesiology (2003) 98,853-61. 

Parecoxib had no effect on the pharmacokinetics of alfentanil or fentanyl, and celecoxib and rofecoxib appeared not to affect the pharmacokinetics of tramadol Coxibs can reduce the perioperative opioid requirement, but adverse effects are not necessarily reduced. 

In a double-blind, placebo-controlled study in 72 patients undergoing laparoscopic cholecystectomy, oral etoricoxib 120 mg given 1.5 hours before surgery reduced the need for postoperative patient controlled analgesia (PCA) with fentanyl, but opioid-related adverse effects were not reduced. Furthermore, the safety of short-term perioperative use of coxibs has been questioned, as some studies have reported more adverse effects (including myocardial infarction, cardiac arrest, stroke, and pulmonary embolism) with parecoxib or valdecoxib compared with placebo. ... 

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