What is sulindac, and how does it work (mechanism of action)?
Sulindac is a
nonsteroidal anti-inflammatory
drug (NSAID) that is used for treating pain, fever, and inflammation. Other
NSAIDs include ibuprofen (Motrin), indomethacin (Indocin), nabumetone (Relafen)
as well as others. They work by reducing the levels of prostaglandins, chemicals
that are produced by the body and are responsible for pain, fever, and
inflammation. Sulindac blocks the enzyme that makes prostaglandins (cyclooxygenase),
resulting in lower concentrations of prostaglandins. As a consequence,
inflammation, pain and fever are reduced. Sulindac was approved by the FDA in
September 1978.
What brand names are available for sulindac?
Clinoril
Is sulindac available as a generic drug?
Yes
Do I need a prescription for sulindac?
Yes
What are the side effects of sulindac?
Most patients benefit from sulindac and other NSAIDs
with few side effects. However, serious side effects can occur and generally
tend to be dose related, that is, they occur more frequently with higher doses.
Therefore, it is advisable to use the lowest effective dose to minimize side
effects.
The most common side effects of sulindac involve the gastrointestinal
system, and these are:
- ulcerations of the stomach and small intestine,
- abdominal pain,
- cramping,
- nausea,
- gastritis,
- serious gastrointestinal bleeding, and
- liver toxicity.
Sometimes, ulceration of the stomach and bleeding can occur
without any abdominal pain, and
black tarry stools, weakness, and dizziness upon
standing (orthostatic hypotension) may be the only signs of internal bleeding.
Other important side effects include:
- rash,
- kidney impairment,
- ringing in the ears, and
- lightheadedness.
Sulindac should be avoided by patients with a history of exacerbation of
asthma, hives, or other allergic reactions to
aspirin or other NSAIDs. Rare but
severe allergic reactions have been reported in such individuals. It also should
be avoided by patients with
peptic ulcer disease or poor kidney function, since
this medication can aggravate both conditions. Fluid retention, blood clots,
heart attacks,
hypertension, and heart failure have also been associated with
the use of NSAIDs such as sulindac.
What is the dosage for sulindac?
The usual adult dose is 150 or 200 mg given twice daily with meals. The maximum dose is 400 mg daily.
Which drugs or supplements interact with sulindac?
Sulindac may increase the blood levels of lithium (Eskalith,
Lithobid) by reducing the elimination of lithium by the kidneys. Increased
levels of lithium may lead to lithium toxicity.
Sulindac may reduce the blood pressure lowering effects of blood pressure
medications. This may occur because prostaglandins have a role in the regulation
(reduction) of blood pressure. Combining NSAIDs such as sulindac with
angiotensin receptor blockers (for example, valsartan [Diovan], losartan [Cozaar],
irbesartan [Avapro]) or
angiotensin converting enzyme (ACE) inhibitors (for
example, enalapril [Vasotec], captopril [Capoten]) in patients who are elderly,
fluid-depleted (including those on diuretic therapy), or with poor kidney
function may result in reduced kidney function, including kidney failure. These
effects usually are reversible.
When sulindac is used in combination with methotrexate (Rheumatrex, Trexall)
or aminoglycoside antibiotics (for example, gentamicin) the blood levels of
methotrexate or aminoglycoside may increase, presumably because the elimination
of methotrexate or aminoglycosides from the body is reduced. This may lead to
more methotrexate or aminoglycoside-related side effects.
Individuals taking oral blood thinners or anticoagulants, for example,
warfarin, (Coumadin), should avoid sulindac because sulindac also thins the
blood, and excessive blood thinning may lead to bleeding.
Persons who consume more than three alcoholic beverages per day are at
increased risk of developing stomach ulcers when taking sulindac or other NSAIDs.
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Is sulindac safe to take if I’m pregnant or breastfeeding?
There are no adequate studies of sulindac in pregnant
women. Therefore, sulindac is not recommended during
pregnancy.
It is not known whether sulindac is excreted in
breast milk.
What else should I know about sulindac?
What preparations of sulindac are available?
tablets: 150 and 200 mg
How should I keep sulindac stored?
Sulndac should be stored in a sealed container and protected from moisture at room temperature, 15-30 C (59-86 F).