Contents:
Guideline statements
- Subcutaneous parecoxib has a potential role in cancer pain management, particularly malignant bone pain, especially in patients who are unable to take medications orally.
- The use of subcutaneous parecoxib in palliative care is off-license for both the route of administration and indication, and this should be discussed with the patient before use.
- Duration of action of parecoxib is reported as 6-12 hours from a single dose (9).
- Onset of analgesic effect has been reported from 23-39 minutes (9).
- Interactions with Parecoxib will be as listed for NSAIDs.
- One notable interaction for palliative care is that if fluconazole is being used concomitantly then the dose of parecoxib needs to be reduced.
- Parecoxib can be given via the subcutaneous route either as once or twice daily injections or as a continuous infusion using a syringe driver (CSCI).
- Dose options are 40mg subcut ONCE or TWICE daily or 40-80mg/24hr subcut CSCI
- The maximum licensed dose is 80mg/24 hours (2).
- In moderate liver impairment, several renal failure (1). and for the elderly (body-weight up to 50kg) (2), an initial dose of 20mg and maximum dose of 40mg per 24 hours may be appropriate.
- Manufacturers also recommend a lower initial dose of 20mg if GFR<30.
- Baseline and repeat monitoring of renal function should be considered, especially in those who may have pre-existing renal impairment, are receiving concomitant nephrotoxic medications, or receive prolonged administration of parecoxib where the risk to renal function could feasibly change.
Disclaimer
These Guidelines are intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
Whilst SPAGG takes every care to compile accurate information , we cannot guarantee its correctness and completeness, and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.