Parecoxib Opioids

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. ... 

Langford RM, Joshi GP, Gan TJ, Mattera MS, Chen WH, Revicki DA, Chen C, Zlateva G. Reduction in opioid-related adverse events and improvement in function with parecoxib followed by val-decoxib treatment after non-cardiac surgery a randomized, double-blind, placebo-controlled, parallel-group trial. Clin Drug Invest 2009 29(9) 577-90. 

More study and research is needed to evaluate parecoxib fully and the possible risks and benefits of its use. The benefits of opioid-sparing effects and decreased bleeding ride must be weighed against the cardiovascular ride in certain patient populations. The data available are still not definitive in the absolute risk profile of parecoxib. The possibiUties for use in non-cardiac patients, as well as the use of other agents in cardiac patients to temper the physiological mechanisms of 247... 

Malan TP Jr, Marsh G, Hakki SI, Grossman E, Traylor L, Hubbard RC. Parecoxib sodium, a parenteral cyclooxygenase 2 selective inhibitor, improves morphine analgesia and is opioid-sparing following total hip arthroplasty. Anesthesiology 2003 98 ... 

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