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Sulindac
Sulindac is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain and reduce inflammation in various conditions, such as arthritis, bursitis, tendinitis, ankylosing spondylitis, and gout. It works by reducing substances in the body that cause pain and inflammation. Sulindac is commonly prescribed for the management of pain associated with chronic inflammatory conditions or acute episodes of inflammation.
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Frequently Asked Questions
How long does it take for sulindac to start working?
Sulindac typically begins to relieve pain and inflammation within a few hours, but full effects may take a few days to a week for chronic conditions like arthritis.
Can I take sulindac with other pain relievers?
You should avoid taking sulindac with other NSAIDs (such as ibuprofen or naproxen) or aspirin, as this increases the risk of gastrointestinal bleeding. Acetaminophen can be taken for additional pain relief, but consult your doctor first.
Can I take sulindac if I am pregnant?
Sulindac, like other NSAIDs, is generally not recommended during pregnancy, particularly during the third trimester, as it can cause complications for both the mother and the baby. Discuss alternatives with your healthcare provider if you are pregnant or planning to become pregnant.
What should I do if I miss a dose of sulindac?
If you miss a dose, take it as soon as you remember. If it’s close to the time of your next dose, skip the missed dose and take the next dose at your regular time. Do not double up to make up for a missed dose.
Is sulindac safe for long-term use?
Sulindac can be used for long-term management of chronic conditions like arthritis, but it comes with risks such as gastrointestinal bleeding, cardiovascular events, and kidney problems. Long-term use should be carefully monitored by your healthcare provider, with regular check-ups to evaluate kidney and liver function, as well as overall health.
Comprehensive Drug Guide
How Does Sulindac Work?
Sulindac works by inhibiting the enzyme cyclooxygenase (COX), which is involved in the synthesis of prostaglandins—substances that mediate pain, inflammation, and fever. By inhibiting COX, sulindac reduces the production of prostaglandins, leading to decreased inflammation, pain, and swelling.
Common Dosages
- 150 mg to 200 mg taken twice daily.
Typical Dosing
- For arthritis or other inflammatory conditions: The typical dose is 150 mg to 200 mg twice daily, depending on the severity of the condition. The dose may be adjusted based on patient response and tolerance.
For acute gout: The usual dose is 200 mg twice daily for 7 to 14 days until symptoms improve.
Typical Dosing
FDA Approved Indications
- Osteoarthritis
- Rheumatoid arthritis
- Ankylosing spondylitis
- Acute gouty arthritis
- Bursitis and tendinitis
Who Shouldn't Take Sulindac?
- History of allergic reactions to NSAIDs or aspirin (e.g., anaphylaxis, hives, or asthma attacks).
- Active gastrointestinal bleeding, ulcers, or history of peptic ulcer disease.
- Severe liver or kidney impairment.
- History of heart attack or stroke, or conditions that increase cardiovascular risk.
- Late-stage pregnancy: NSAIDs can cause complications during the third trimester.
Advice From The Pharmacist
- Take sulindac with food or milk to reduce the risk of stomach upset or irritation. Avoid taking it on an empty stomach.
- Stay hydrated while on sulindac, as NSAIDs can affect kidney function.
- Do not exceed the prescribed dose, as higher doses or prolonged use increase the risk of serious side effects, including gastrointestinal bleeding and cardiovascular events.
- Limit alcohol consumption while taking sulindac, as alcohol can increase the risk of stomach bleeding.
- Monitor for signs of gastrointestinal distress, such as stomach pain, heartburn, or black stools, which could indicate a bleeding ulcer.
Side Effects of Sulindac
Common Side Effects
- Upset stomach
- Nausea or vomiting
- Heartburn
- Diarrhea
- Headache
- Dizziness
Uncommon/Severe Side Effects
- Gastrointestinal bleeding: Signs include black, tarry stools, or vomiting blood.
- Heart attack or stroke: Especially in long-term use or in patients with cardiovascular disease.
- Kidney problems: Signs include reduced urine output or swelling in the legs.
- Liver toxicity: Symptoms may include jaundice (yellowing of the skin or eyes), dark urine, or severe fatigue.
- Allergic reactions: Rash, hives, swelling, or difficulty breathing.
Risks and Warnings of Sulindac
- Cardiovascular Risk: NSAIDs, including sulindac, can increase the risk of heart attack or stroke, especially with long-term use or in individuals with pre-existing heart conditions. Patients with cardiovascular risk factors should use sulindac with caution and consult their healthcare provider.
- Gastrointestinal Risk: Sulindac can cause gastrointestinal bleeding, ulcers, or perforations, especially in elderly patients or those with a history of ulcers or gastrointestinal disorders. The risk increases with higher doses and prolonged use.
- Kidney Function: Long-term use of sulindac may impair kidney function, particularly in individuals with pre-existing kidney disease. Regular monitoring of kidney function is recommended during treatment.
- Liver Toxicity: Sulindac can cause liver toxicity in rare cases, leading to jaundice, elevated liver enzymes, or liver failure. Liver function tests should be monitored periodically, especially in long-term use.
Interactions with Sulindac
Common Drug Interactions
- Anticoagulants (e.g., warfarin): Sulindac can increase the risk of bleeding when taken with anticoagulants. Close monitoring of bleeding risk is necessary.
- ACE inhibitors or ARBs: The use of NSAIDs with these blood pressure medications may reduce their effectiveness and increase the risk of kidney damage.
- Diuretics: NSAIDs can reduce the effectiveness of diuretics and may increase the risk of kidney problems.
- Other NSAIDs or corticosteroids: Combining sulindac with other NSAIDs or corticosteroids increases the risk of gastrointestinal bleeding and ulcers.
Alternatives to Sulindac
- Ibuprofen (Advil, Motrin): Another commonly used NSAID for pain and inflammation.
- Naproxen (Aleve): A longer-acting NSAID used for pain and inflammation management.
- Celecoxib (Celebrex): A COX-2 selective NSAID that has a lower risk of gastrointestinal side effects but still carries cardiovascular risks.
- Meloxicam (Mobic): An NSAID used for long-term management of arthritis and similar conditions.
- Acetaminophen (Tylenol): An analgesic and antipyretic that does not have anti-inflammatory properties but is a safer alternative for those with gastrointestinal risks.
