Nonsteroidal Anti-Inflammatory Agent (NSAID)
Management of inflammatory disease, rheumatoid disorders, acute gouty
arthritis, structurally similar to indomethacin but acts like aspirin; safest
NSAID for use in mild renal impairment
B (D in 3rd trimester)
Hypersensitivity to sulindac, any component, aspirin or other nonsteroidal
anti-inflammatory drugs (NSAIDs)
Use with caution in patients with peptic ulcer disease, GI bleeding, bleeding
abnormalities, dehydration, impaired renal or hepatic function, congestive heart
failure, hypertension, and patients receiving
Central nervous system: Dizziness
Gastrointestinal: Abdominal cramps, heartburn, indigestion, nausea
1% to 10%:
Central nervous system: Headache, nervousness
Endocrine & metabolic: Fluid retention
<1%: Congestive heart failure, hypertension, arrhythmias, tachycardia,
confusion, hallucinations, aseptic meningitis, mental depression, drowsiness,
insomnia, urticaria, erythema multiforme, toxic epidermal necrolysis,
Stevens-Johnson syndrome, angioedema, polydipsia, hot flashes, gastritis, GI
ulceration, cystitis, polyuria, agranulocytosis, anemia, hemolytic anemia, bone
marrow suppression, leukopenia, thrombocytopenia, hepatitis, peripheral
neuropathy, toxic amblyopia, blurred vision, conjunctivitis, dry eyes, decreased
hearing, acute renal failure, allergic rhinitis, shortness of breath, epistaxis
Symptoms of overdose include dizziness, vomiting, nausea, abdominal pain,
hypotension, coma, stupor, metabolic acidosis, leukocytosis, renal failure
Management of a nonsteroidal anti-inflammatory drug (NSAID) intoxication is
primarily supportive and symptomatic. Fluid therapy is commonly effective in
managing the hypotension that may occur following an acute NSAID overdose,
except when this is due to an acute blood loss. Seizures tend to be very
short-lived and often do not require drug treatment; although, recurrent
seizures should be treated with I.V. diazepam.
Decreased effect of diuretics, beta-blockers, hydralazine, ACE inhibitors
Increased toxicity with probenecid, NSAIDs; increased toxicity of digoxin,
methotrexate, lithium, aminoglycosides antibiotics (reported in neonates),
cyclosporine (increased nephrotoxicity), potassium-sparing diuretics
Inhibits prostaglandin synthesis by decreasing the activity of the enzyme,
cyclo-oxygenase, which results in decreased formation of prostaglandin
Onset of effect: Analgesic: ~1 hour
Duration: 12-24 hours
Metabolism: Sulindac is a prodrug and, therefore, requires metabolic
activation; requires hepatic metabolism to sulfide metabolite (active) for
therapeutic effects; also metabolized in the liver to sulfone metabolites
Half-life: Parent drug: 7 hours; Active metabolite: 18 hours
Elimination: Principally in urine (50%) with some biliary excretion (25%)
Maximum therapeutic response may not be realized for up to 3 weeks
Children: Dose not established
Adults: 150-200 mg twice daily or 300-400 mg once daily; not to exceed 400
Dosing adjustment in hepatic impairment: Dose reduction is necessary
Food: May decrease the rate but not the extent of oral absorption. Drug may
cause GI upset, bleeding, ulceration, perforation; take with food or milk to
minimize GI upset.
Liver enzymes, BUN, serum creatinine, CBC, blood
|Mental Health: Effects
on Mental Status|
Dizziness is common; may cause nervousness; may rarely cause drowsiness,
confusion, insomnia, hallucinations, or depression
Effects on Psychiatric
May rarely cause agranulocytosis; use caution with clozapine and
carbamazepine; may decrease lithium clearance (evidence suggests that this
effect may be less than with other NSAIDs) resulting in an increase in serum
lithium levels and potential lithium toxicity; monitor serum lithium
|Dental Health: Local
No information available to require special precautions
Effects on Dental Treatment|
NSAID formulations are known to reversibly decrease platelet aggregation via
mechanisms different than observed with aspirin. The dentist should be aware of
the potential of abnormal coagulation. Caution should also be exercised in the
use of NSAIDs in patients already on anticoagulant therapy with drugs such as
Take this medication exactly as directed; do not increase dose without
consulting prescriber. Take with food or milk to reduce GI distress. Maintain
adequate fluid intake (2-3 L/day of fluids unless instructed to restrict fluid
intake). Do not use alcohol, aspirin, or aspirin-containing medication, and all
other anti-inflammatory medications without consulting prescriber. You may
experience dizziness, nervousness, or headache (use caution when driving or
engaging in tasks requiring alertness until response to drug is known); nausea,
vomiting, or heartburn (frequent small meals, frequent mouth care, sucking
lozenges, or chewing gum may help); constipation (increased exercise, fluids, or
dietary fruit and fiber may help). GI bleeding, ulceration, or perforation can
occur with or without pain; discontinue medication and contact prescriber if
persistent abdominal pain or cramping, or blood in stool occurs. Report
breathlessness or difficulty breathing; unusual bruising/bleeding; blood in
urine, stool, mouth, or vomitus; unusual fatigue; skin rash or itching; change
in urinary pattern; or change in hearing or ringing in ears.
Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend
to be pregnant. Consult prescriber if breast-feeding.
Observe for edema and fluid retention; monitor blood
Tablet: 150 mg, 200 mg
A suspension of sulindac can be prepared by triturating 1000 mg sulindac (5 x
200 mg tablets) with 50 mg of kelco and 400 mg of Veegum®
until a powder mixture is formed; then add 30 mL of sorbitol 35% (prepared from
70% sorbitol) to form a slurry; finally add a sufficient quantity of 35%
sorbitol to make a final volume of 100 mL; the final suspension is 10 mg/mL and
is stable for 7 days
Brooks PM and Day RO,
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Clinch D, Banerjee AK, Ostick G,
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