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PAIN MEDICINE

The Influence of Parecoxib, a Parenteral Cyclooxygenase-2 Specific Inhibitor, on the Pharmacokinetics and Clinical Effects of Midazolam

Andra Ibrahim, MD^*, Aziz Karim, PhD, Jennifer Feldman, BA^*, and Evan Kharasch, MD PhD^*

Departments of *Anesthesiology and Medicinal Chemistry, University of Washington, Seattle, Washington; and Pharmacia, Inc., Skokie, Illinois

Address correspondence and reprint requests to Evan D. Kharasch, MD, PhD, Department of Anesthesiology, University of Washington, Box 356540, 1959 NE Pacific, RR-442, Seattle, WA 98195. Address e-mail to kharasch{at}u.washington.edu

Parecoxib, a parenteral cyclooxygenase-2 inhibitor, is undergoing clinical development as an analgesic/antiinflammatory drug for perioperative use. Parecoxib, an inactive prodrug, is hydrolyzed in vivo to valdecoxib, a substrate for hepatic cytochrome P450 (CYP) 3A4. Thus, potential exists for interactions with other CYP3A4 substrates. In this investigation, we determined the influence of parecoxib on the pharmacokinetics and clinical effects of midazolam, a CYP3A4 substrate, in volunteers. This was a randomized, balanced crossover, placebo-controlled, double-blinded clinical investigation. Twelve healthy subjects aged 23–41 yr were studied after providing IRB-approved informed consent. Midazolam 0.07 mg/kg IV infusion was administered 1 h after placebo (control) or parecoxib 40 mg IV. Venous midazolam concentrations were determined by using liquid chromatography-mass spectrometry/mass spectrometry assay. Pharmacokinetic variables were determined by noncompartmental analysis. Pharmacodynamic measurements included clinical end-points, cognitive function (memory; digit symbol substitution tests), subjective self-assessment of recovery (visual analog scales), and bispectral index. Midazolam plasma concentrations were similar between placebo and parecoxib-treated subjects. No differences were found in midazolam pharmacokinetics (maximal observed plasma concentration, clearance, elimination half-life, volume of distribution) or pharmacodynamics (clinical end-points, digit symbol substitution tests, memory, visual analog scales, bispectral index). Single-bolus parecoxib does not alter the pharmacokinetics or pharmacodynamics of midazolam infusion. Parecoxib did not affect CYP3A4 activity as assessed using midazolam clearance as the in vivo probe.

IMPLICATIONS: Parecoxib, a parenteral cyclooxygenase-2 inhibitor intended for perioperative use as an analgesic/antiinflammatory drug, is a substrate for hepatic cytochrome P450 3A4. The potential for a drug interaction with midazolam, an in vivo CYP3A4 probe, was tested in healthy volunteers. Single-bolus parecoxib does not alter the pharmacokinetics or pharmacodynamics of midazolam.

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				C. M Amabile and A. P Spencer Parecoxib for Parenteral Analgesia in Postsurgical Patients Ann. Pharmacother., May 1, 2004; 38(5): 882 - 886. [Abstract] [Full Text] [PDF]