Dynastat
parecoxib
parecoxib
Keep this leaflet. You may need to read it again.
If you have further questions, ask your doctor or nurse.
If you get any side effects, talk to your doctor or nurse. This includes any possible side effects not listed in this leaflet. See section 4.
What Dynastat is and what it is used for
What you need to know before you use Dynastat
How to use Dynastat
Possible side effects
How to store Dynastat
Contents of the pack and other information
Dynastat contains the active substance parecoxib.
Dynastat is used for the short-term treatment of pain in adults after an operation. It is one of a family of medicines called COX-2 inhibitors (this is short for cyclo-oxygenase-2 inhibitors). Pain and swelling are sometimes caused by substances in the body called prostaglandins. Dynastat works by lowering the amount of these prostaglandins.
if you are allergic to parecoxib or any of the other ingredients of this medicine (listed in section 6)
if you have had a serious allergic reaction (especially a serious skin reaction) to any medicines
if you have had an allergic reaction to a group of medicines called “sulfonamides” (e.g. some antibiotics used to treat infections)
if you currently have a gastric or intestinal ulcer or bleeding in the stomach or gut
if you have had an allergic reaction to acetylsalicylic acid (aspirin) or to other NSAIDs (e.g. ibuprofen) or to COX-2 inhibitors. Reactions might include wheezing (bronchospasm), badly blocked nose, itchy skin, rash or swelling of the face, lips or tongue, other allergic reactions or nasal polyps after taking these medicines
if you are more than 6 months pregnant
if you are breast-feeding
if you have severe liver disease
if you have inflammation of the intestines (ulcerative colitis or Crohn’s disease)
if you have heart failure
if you are about to have heart surgery or surgery on your arteries (including any coronary artery procedure)
if you have established heart disease and /or cerebrovascular disease e.g. if you have had a heart attack, stroke, mini-stroke (TIA) or blockages to blood vessels to the heart or brain or an operation to clear or bypass blockages
if you have or have had problems with your blood circulation (peripheral arterial disease)
If any of these applies to you, you will not be given the injection. Tell your doctor or nurse immediately.
If you have previously had an ulcer, bleeding or perforation of the gastrointestinal tract.
If you are taking acetylsalicylic acid (aspirin) or other NSAIDs (e.g. ibuprofen)
If you smoke or drink alcohol
If you have diabetes
If you have angina, blood clots, high blood pressure or raised cholesterol
If you are taking antiplatelet therapies
If you have fluid retention (oedema)
If you have liver or kidney disease.
If you are dehydrated – this may happen if you have had diarrhoea or have been vomiting (being sick) or unable to drink fluids
If you have an infection as it may hide a fever (which is a sign of infection)
If you use medicines to reduce blood clotting (e.g. warfarin/warfarin like anticoagulants or novel oral anti-clotting medicines, e.g. apixaban, dabigatran, and rivaroxaban)
If you use medicines called corticosteroids (e.g. prednisone)
If you use a class of medicines used to treat depression called selective serotonin re-uptake inhibitors (e.g. sertraline)
Dynastat can lead to an increase in blood pressure or worsening of existing high blood pressure which may result in an increase in side effects associated with heart conditions. Your doctor may want to monitor your blood pressure during treatment with Dynastat.
Children and adolescents under the age of 18 should not be given Dynastat.
Tell your doctor or nurse if you are taking, have recently taken or might take any other medicines. Medicines can sometimes interfere with each other. Your doctor may reduce the dose of Dynastat or other medicines, or you may need to take a different medicine. It’s especially important to mention:
Acetylsalicylic acid (aspirin) or other anti-inflammatory medicines
Fluconazole – used for fungal infections
ACE inhibitors, Angiotensin-II inhibitors, beta blockers and diuretics – used for high blood pressure and heart conditions
Ciclosporin or Tacrolimus – used after transplants
Warfarin – or other warfarin like medicines used to prevent blood clots including newer medicines like apixaban, dabigatran, and rivaroxaban
Lithium – used to treat depression
Rifampicin – used for bacterial infections
Antiarrhythmics – used to treat an irregular heartbeat
Phenytoin or Carbamazepine – used for epilepsy
Methotrexate – used for rheumatoid arthritis and cancer
Diazepam – used for sedation and anxiety
Omeprazole – used for treating ulcers
NSAIDs, including Dynastat, may make it more difficult to become pregnant. You should tell your doctor if you are planning to become pregnant or if you have problems becoming pregnant.
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or nurse for advice before taking this medicine.
If the injection makes you feel dizzy or tired, do not drive or use machines until you feel better again.
This medicine contains less than 1 mmol sodium (23 mg) per ml that is to say essentially ‘sodium-free’.
Dynastat will be given to you by a doctor or nurse. They will dissolve the powder before giving you the injection, and will inject the solution into a vein or a muscle. The injection may be given rapidly and directly into a vein or into an existing intravenous line (a thin tube running into a vein), or it can be given slowly and deeply into a muscle. You will only be given Dynastat for short periods, and only for pain relief.
You may be given another dose – either 20 mg or 40 mg – 6 to 12 hours after the first one.
People with liver problems
People with severe kidney problems
Patients over 65 who weigh less than 50 kg
People taking fluconazole.
If you have any further questions on the use of this medicine, ask your doctor or nurse.
Like all medicines, this medicine can cause side effects, although not everybody gets them.
if you develop a rash or ulceration in any part of your body (e.g. skin, mouth, eyes, face, lips or tongue), or develop any other signs of an allergic reaction such as skin rash, swelling of the face, lips or tongue which may cause wheezing, difficulty breathing, or swallowing – this occurs rarely
if you have blistering or peeling of the skin - this occurs rarely
the onset of skin reactions can occur at any time but most often occur in the first month of treatment; the reported rate of these events appears to be greater for valdecoxib, a medicine related to parecoxib, as compared to other COX-2 inhibitors
if you have jaundice (your skin or the whites of your eyes appear yellow)
if you have any signs of bleeding in the stomach or intestine, such as passing a black or blood-stained bowel movement or vomiting blood
Nausea (feeling sick)
Change in your blood pressure (up or down)
You may get back pain
Ankles, legs and feet may swell (fluid retention)
You may feel numb – your skin may lose sensitivity to pain and touch
You may get vomiting, stomach ache, indigestion, constipation, bloating and wind
Tests may show abnormal kidney function
You may feel agitated or find it hard to sleep
Dizziness
There is a risk of anaemia - changes in red blood cells after an operation that may cause fatigue and breathlessness
You may get a sore throat or difficulty breathing (shortness of breath)
Your skin may be itchy
You may pass less urine than usual.
Dry socket (inflammation and pain after a tooth extraction)
Increased sweating
Low levels of potassium in blood test results
Heart attack
There is a risk of cerebrovascular disease e.g. stroke, or transient ischaemic attack (transient reduced blood flow to the brain)/mini-stroke or angina, or blockages to blood vessels to the heart or brain
Blood clot in the lungs
Worsening of high blood pressure
Ulcers in the digestive system, chronic stomach acid reflux
The heart may beat more slowly
Low blood pressure on standing
Blood tests may show abnormal liver function
You may bruise easily due to a low blood platelet count
Surgical wounds may become infected, abnormal discharge from surgical wounds
Skin discolouration or bruising
Complications with skin healing after operations
High sugar levels in blood tests
Injection site pain or injection site reaction
Rash, or raised itchy rash (hives)
Anorexia (loss of appetite)
Joint pain
High levels of blood enzymes in blood tests that indicate injury or stress to the heart, the brain, or muscle tissue.
Dry mouth
Muscle weakness
Ear ache
Unusual abdominal sounds
Rash or ulceration in any part of your body (e.g. skin, mouth, eyes, face, lips or tongue), or any other signs of allergic reactions such as skin rash, swelling of the face, lips and tongue, wheezing, difficulty breathing or swallowing (potentially fatal)
Swelling, blistering or peeling of the skin
Acute kidney failure
Hepatitis (inflamed liver)
Inflammation of the gullet (oesophagus)
Inflammation of the pancreas (can lead to stomach pain)
Collapse due to severe low blood pressure
Heart failure
Kidney failure
Racing or irregularity of the heartbeat
Breathlessness
If you get any side effects, talk to your doctor or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via thenationalreportingsystemlistedin Appendix V. By reporting side effects you can help provide more information on the safety of this medicine.
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the carton and on the vial label after Exp. The expiry date refers to the last day of that month.
This medicine does not require any special storage conditions prior to reconstitution.
It is recommended that Dynastat is used as soon as possible after it is mixed with solvent, although it may be stored if the instructions at the end of the leaflet are strictly followed.
The injection solution should be a clear colourless liquid. If there are particles in the injection solution or if either the powder or solution is discoloured, the solution will not be used.
The active substance is parecoxib (as parecoxib sodium). Each vial contains 40 mg parecoxib, as
42.36 mg parecoxib sodium. When reconstituted with 2 ml solvent, provides 20 mg/ml of parecoxib. When reconstituted in sodium chloride 9 mg/ml (0.9%) solution, Dynastat contains approximately 0.44 mEq of sodium per vial.
The other ingredients are:
Disodium hydrogen phosphate
Phosphoric acid and/or sodium hydroxide (for pH adjustment).
Dynastat is available as a white to off-white powder.
The powder is contained in colourless glass vials (5 ml) with a stopper, sealed with a purple flip-off cap on the aluminium overseal.
Marketing Authorisation Holder: Pfizer Europe MA EEIG, Boulevard de la Plaine 17, 1050 Bruxelles, Belgium
Manufacturer: Pfizer Manufacturing Belgium NV, Rijksweg 12, 2870 Puurs, Belgium
For any information about this medicinal product, please contact the local representative of the Marketing Authorisation Holder.
Pfizer S.A./ N.V.
Tél/Tel: +32 (0)2 554 62 11
Pfizer Luxembourg SARL filialas Lietuvoje. Tel. +3705 2514000
Пфайзер Люксембург САРЛ, Клон България Тел.: +359 2 970 4333
Pfizer S.A.
Tél/Tel: +32 (0)2 554 62 11
Pfizer, spol. s r.o.
Tel: +420 283 004 111
Pfizer Kft.
Tel: + 36 1 488 37 00
Pfizer ApS
Tlf: +45 44 20 11 00
Vivian Corporation Ltd. Tel: +356 21344610
Pfizer Pharma GmbH
Tel: +49 (0)30 550055 51000
Pfizer bv
Tel: +31 (0)10 406 4301
Pfizer Luxembourg SARL Eesti filiaal Tel: +372 666 7500
Pfizer AS
Tlf: +47 67 52 61 00
PFIZER ΕΛΛΑΣ A.E., Τλ: +30 210 67 85 800
Pfizer Corporation Austria Ges.m.b.H. Tel: +43 (0)1 521 15-0
Pfizer, S.L.
Tel: +34 91 490 99 00
Pfizer Polska Sp. z o.o., Tel.: +48 22 335 61 00
Pfizer
Tél: +33 (0)1 58 07 34 40
Laboratórios Pfizer, Lda. Tel: +351 21 423 5500
Pfizer Croatia d.o.o. Tel: + 385 1 3908 777
Pfizer România S.R.L. Tel: +40 (0)21 207 28 00
Pfizer Healthcare Ireland Tel: 1800 633 363 (toll free)
+ 44 (0)1304 616161
Pfizer Luxembourg SARL
Pfizer, podružnica za svetovanje s področja farmacevtske dejavnosti, Ljubljana
Tel: + 386 (0)152 11 400
Icepharma hf.
Sími: + 354 540 8000
Pfizer Luxembourg SARL, organizačná zložka Tel: +421–2–3355 5500
Pfizer S.r.l.
Tel: +39 06 33 18 21
Pfizer Oy
Puh/Tel: +358(0)9 43 00 40
PFIZER ΕΛΛΑΣ Α.Ε. (Cyprus Branch) Τηλ: +357 22 817690
Pfizer AB
Tel: +46 (0)8 550 520 00
Pfizer Luxembourg SARL filiāle Latvijā Tel: +371 670 35 775
Pfizer Limited
Tel: +44 (0)1304 616161
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There is limited clinical experience with Dynastat treatment beyond three days.
As the cardiovascular risk of cyclooxygenase-2 (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.
Cases of severe hypotension shortly following parecoxib administration have been reported in postmarketing experience with parecoxib. Some of these cases have occurred without other signs of anaphylaxis. The physician should be prepared to treat severe hypotension.
Modes of administration other than IV or IM (e.g. intra-articular, intrathecal) have not been studied and should not be used.
sodium chloride 9 mg/ml (0.9%) solution for injection/infusion;
glucose 50 mg/ml (5%) solution for infusion; or
sodium chloride 4.5 mg/ml (0.45%) and glucose 50 mg/ml (5%) solution for injection/infusion.
The following solutions cannot be used for reconstitution:
Use of Ringer-Lactate solution for injection or glucose 50 mg/ml (5%) in Ringer-Lactate solution for injection for reconstitution will cause the parecoxib to precipitate from solution and therefore is not recommended.
Use of Sterile Water for Injection for reconstitution is not recommended, as the resulting
solution is not isotonic.
40 mg vial: Remove the purple flip-off cap to expose the central portion of the rubber stopper of the parecoxib 40 mg 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 parecoxib 40 mg vial.
Precipitation may occur when Dynastat is combined in solution with other medicinal products and therefore Dynastat must not be mixed with any other drug, 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.
sodium chloride 9 mg/ml (0.9%) solution for injection/infusion;
glucose 50 mg/ml (5%) solution for infusion;
sodium chloride 4.5 mg/ml (0.45%) and glucose 50 mg/ml (5%) solution for injection/infusion; or
Ringer-Lactate solution for injection.
Chemical and physical in-use stability of the reconstituted solution have been demonstrated for up to 24 hours at 25C. 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 25C.