Drug reference

Sulindac

NSAID · Anti-inflammatory

NSAIDAnti-inflammatory

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Manufacturers advise avoid—no information

FDA category + note

Top interactionssee all 12 →

AminoglycosideSevereTextbookKDT 7e · p746
AminoglycosidesSevereTextbookKDT 7e
AnticoagulantsSevereTextbookKDT 7e
CorticosteroidsSevereTextbookKDT 7e

Mechanism

Sulindac is a prodrug that is converted to an active sulfide metabolite. This active metabolite non-selectively inhibits both cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzymes. Inhibition of COX enzymes reduces the synthesis of prostanoids, which are mediators of inflammation and pain.

Indications

ArthritisJuvenile Idiopathic Arthritis (JIA)Rheumatoid arthritisOsteoarthritisAnkylosing spondylitisPainful shoulderGouty arthritisInflammatory diseases

Dosing

Adult: l INDICATIONS AND DOSE ▶ BY MOUTH Adult: 1250 mg once daily, review treatment if no beneﬁt after 2–3 months DOLENIO ® Symptomatic relief of mild to moderate osteoarthritis of the knee ▶ BY MOUTH Adult: 1500 mg once daily, review treatment if no beneﬁt after 2–3 months GLUSARTEL ® Symptomatic relief of mild to moderate osteoarthritis of the knee ▶ BY MOUTH Adult: 1500 mg once daily, dose to be diss…

Pharmacokinetics

Onset

Peak plasma concentration (Cp) 1–2 h (active metabolite 8 h)

Duration

Active metabolite t1/2 is 18 h with extensive enterohepatic circulation.

Half-life

7 h; 18 h for active sulfone metabolite

Metabolism

Prodrug, converted to active sulfide metabolite

Contraindications

Precautions for patients at risk for GI toxicity (similar to other NSAIDs)
Precautions for patients with cardiovascular risk (similar to other NSAIDs)
Precautions for patients with renal impairment (similar to other NSAIDs)

Side effects

Common

Gastric and duodenal ulcersGI side effects (20%)CNS side effects (10%, e.g., headache, dizziness, rash)Typical NSAID GI side effects in nearly 20% of patientsCNS side effects (as described for indomethacin) in 10% or fewer of patientsRash (3% to 9% of patients)Pruritus (1% to 3% of patients)Transient elevations of hepatic transaminases in plasma (less common)

Serious

Increased risk of gastrointestinal bleeding (when co-administered with warfarin)

Pregnancy & lactation

Pregnancy

Manufacturers advise avoid—no information

Drug interactions

Aminoglycoside

Severe

Textbook

Increased risk of nephrotoxicity.

Avoid concurrent use.

Source: KDT 7e · p746

Aminoglycosides

Severe

Textbook

Increased aminoglycoside levels and potential toxicity.

Monitor aminoglycoside levels and renal function; adjust dosage as needed.

Source: KDT 7e

Anticoagulants

Severe

Textbook

Increased risk of gastrointestinal bleed.

Monitor for bleeding; consider alternative analgesics or gastroprotective agents.

Source: KDT 7e

Corticosteroids

Severe

Textbook

Increased risk of gastrointestinal bleed.

Monitor for bleeding; consider gastroprotective agents.

Source: KDT 7e

Dapoxetine

Severe

Textbook

Increased risk of gastrointestinal bleed.

Monitor for bleeding; consider gastroprotective agents or alternative analgesics.

Source: KDT 7e

Enalaprilat

Severe

Textbook

Reduced effectiveness of ACE inhibitors. Marked hyperkalemia, potentially leading to cardiac arrhythmia.

Use with caution, especially in the elderly and in patients with hypertension, diabetes mellitus, or ischemic heart disease.

Source: G&G 14e · p836

Escitalopram + Clonazepam

Severe

Textbook

Increased risk of gastrointestinal bleed.

Monitor for bleeding; consider gastroprotective agents or alternative analgesics.

Source: KDT 7e

Glucocorticoids

Severe

Textbook

Increased risk of gastritis, ulcer formation, and gastrointestinal bleeding. Glucocorticoids can also mask the symptoms of serious gastrointestinal disease, increasing the risk of perforated sigmoid diverticular abscesses.

Not explicitly stated, but implies caution and awareness of increased risk.

Source: G&G 14e · p1013

Quinolones

Severe

Textbook

Enhanced neurological adverse effects.

Use with caution, especially in patients with a history of epilepsy.

Source: G&G 14e · p1144

Acalabrutinib

Severe

Database

Drug interaction classified as: synergy