Source: European Medicines Agency (EU) Revision Year: 2021 Publisher: Pfizer Europe MA EEIG, Boulevard de la Plaine 17, 1050 Bruxelles, Belgium
For the short-term treatment of postoperative pain in adults.
The decision to prescribe a selective cyclooxygenase-2 (COX-2) inhibitor should be based on an assessment of the individual patient’s overall risks (see sections 4.3 and 4.4).
The recommended dose is 40 mg administered intravenously (IV) or intramuscularly (IM), followed every 6 to 12 hours by 20 mg or 40 mg as required, not to exceed 80 mg/day.
As the cardiovascular risk of COX-2 specific inhibitors may increase with dose and duration of exposure, the shortest duration possible and the lowest effective daily dose should be used. There is limited clinical experience with Dynastat treatment beyond three days (see section 5.1).
Opioid analgesics can be used concurrently with parecoxib, dosing as described in the paragraph above. In all clinical assessments parecoxib was administered at a fixed time interval whereas the opioids were administered on as needed basis.
No dose adjustment is generally necessary in elderly patients (≥65 years). However, for elderly patients weighing less than 50 kg, treatment should be initiated with half the usual recommended dose of Dynastat and reduce the maximum daily dose to 40 mg (see section 5.2).
There is no clinical experience in patients with severe hepatic impairment (Child-Pugh score 10), therefore its use is contraindicated in these patients (see sections 4.3 and 5.2). No dosage adjustment is generally necessary in patients with mild hepatic impairment (Child-Pugh score 5-6). Dynastat should be introduced with caution and at half the usual recommended dose in patients with moderate hepatic impairment (Child-Pugh score 7-9) and the maximum daily dose should be reduced to 40 mg.
In patients with severe renal impairment (creatinine clearance <30 ml/min.) or patients who may be predisposed to fluid retention, parecoxib should be initiated at the lowest recommended dose (20 mg) and the patient’s kidney function should be closely monitored (see sections 4.4 and 5.2). On the basis of pharmacokinetics, no dose adjustment is necessary in patients with mild to moderate renal impairment (creatinine clearance of 30-80 ml/min.).
The safety and efficacy of parecoxib in children under 18 years old have not been established. No data are available. Therefore, parecoxib is not recommended in these patients.
The IV bolus injection may be given rapidly and directly into a vein or into an existing IV line. The IM injection should be given slowly and deeply into the muscle. For instructions on reconstitution of the medicinal product before administration, see section 6.6.
Precipitation may occur when Dynastat is combined in solution with other medicinal products and therefore Dynastat must not be mixed with any other medicinal product, either during reconstitution or injection. In those patients where the same IV line is to be used to inject another medicinal product, the line must be adequately flushed prior to and after Dynastat injection with a solution of known compatibility.
After reconstitution with acceptable solvents, Dynastat may only be injected IV or IM, or into IV lines delivering the following:
Injection into an IV line delivering glucose 50 mg/ml (5%) in Ringer-Lactate solution for injection, or other IV fluids not listed above, is not recommended as this may cause precipitation from solution.
Reporting of overdose with parecoxib has been associated with adverse reactions which have also been described with recommended doses of parecoxib.
In case of overdose, patients should be managed by symptomatic and supportive care. Valdecoxib is not removed by haemodialysis. Diuresis or alkalisation of urine may not be useful due to high protein binding of valdecoxib.
The shelf life of the unreconstituted product is 3 years.
Chemical and physical in-use stability of the reconstituted solution, which should not be refrigerated or frozen, have been demonstrated for up to 24 hours at 25°C. Thus, 24 hours should be considered the maximum shelf life of the reconstituted product. However, due to the importance of microbiological infection risk for injectable products, the reconstituted solution should be used immediately unless reconstitution has taken place in controlled and validated aseptic conditions. Unless such requirements are met, in-storage times and conditions prior to use are the responsibility of the user, and would not normally be longer than 12 hours at 25°C.
This medicinal product does not require any special storage conditions prior to reconstitution.
For storage conditions of the reconstituted medicinal product see section 6.3.
Type I colourless glass vials (5 ml) with a butyl rubber stopper, sealed with a purple polypropylene flip-off cap on the aluminium overseal.
Dynastat is available in packs containing 10 vials.
Dynastat must be reconstituted before use. Dynastat is preservative free. Aseptic technique is required for its preparation.
Acceptable solvents for reconstitution of Dynastat are:
Use aseptic technique to reconstitute lyophilised parecoxib (as parecoxib).
Remove the purple flip-off cap to expose the central portion of the rubber stopper of the 40 mg parecoxib vial. Withdraw, with a sterile needle and syringe, 2 ml of an acceptable solvent and insert the needle through the central portion of the rubber stopper transferring the solvent into the 40 mg vial. Dissolve the powder completely using a gentle swirling motion and inspect the reconstituted product before use. The entire contents of the vial should be withdrawn for a single administration.
After reconstitution, the liquid should be a clear solution. Dynastat should be inspected visually for particulate matter and discoloration prior to administration. The solution should not be used if discolored or cloudy, or if particulate matter is observed. Dynastat should be administered within 24 hours of reconstitution (see section 6.3), or discarded.
The reconstituted product is isotonic.
After reconstitution with acceptable solvents, Dynastat may only be injected IV or IM, or into IV lines delivering:
For single use only. Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
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