Do Not Increase Sulindac Dose for Fibromyalgia
You should not increase your sulindac dose because NSAIDs are not effective for fibromyalgia pain and are specifically recommended against for this condition. 1, 2 You are already at the maximum recommended dose of 400 mg daily (150 mg twice daily = 300 mg/day is standard, with 400 mg/day being the absolute maximum), and increasing further would exceed FDA-approved dosing limits without providing benefit for your condition 3.
Why Sulindac Is Not Appropriate for Fibromyalgia
The 2022 VA/DoD guidelines for chronic multisymptom illness explicitly suggest against offering NSAIDs for chronic pain related to fibromyalgia 1. The 2017 EULAR fibromyalgia guidelines similarly provide a weak recommendation against NSAIDs, noting that two small trials showed no evidence of improved outcomes compared to placebo 2. This is because fibromyalgia involves abnormal central pain processing rather than peripheral inflammation—NSAIDs target inflammation that isn't the primary problem in your condition.
Maximum Dosing Considerations
According to FDA labeling, sulindac dosing is 3:
- Standard dose for arthritis: 150 mg twice daily (300 mg/day)
- Absolute maximum: 400 mg per day
- Explicit warning: "Dosages above 400 mg per day are not recommended"
You're currently at 300 mg/day, which is already the standard therapeutic dose. The FDA label states to "use the lowest effective dose for the shortest duration" 3.
What You Should Use Instead
The most recent and highest-quality evidence supports these first-line medications for fibromyalgia pain 1, 4, 2:
First-Line Pharmacologic Options:
- Duloxetine (SNRI): 30-60 mg daily, can increase to 60-120 mg daily—FDA-approved for fibromyalgia 4, 2
- Milnacipran (SNRI): FDA-approved for fibromyalgia 4
- Pregabalin: Starting 50 mg three times daily, increase to 100 mg three times daily (maximum 600 mg/day in divided doses)—FDA-approved for fibromyalgia 4, 2
- Amitriptyline: 10-25 mg nightly, increase to 50-150 mg nightly (though evidence is limited and it's potentially inappropriate for those ≥65 years due to anticholinergic effects) 4
Non-Pharmacologic Options (Equally Important):
- Cognitive-behavioral therapy: Suggested for fibromyalgia 1
- Exercise programs: Suggested for fibromyalgia 1
- Yoga or tai chi: Suggested for fibromyalgia 1
- Manual acupuncture: Suggested as part of management 1
Critical Safety Concern
Long-term NSAID use (which you're currently doing) carries significant cardiovascular and gastrointestinal risks, particularly with chronic pain conditions 4. The 2022 CDC opioid guideline notes NSAIDs should be "used with caution, particularly in older persons and in patients with cardiovascular comorbidities, chronic renal failure, or previous gastrointestinal bleeding" 4.
Recommended Action Plan
- Do not increase sulindac dose—you're at maximum recommended dosing and it's ineffective for fibromyalgia
- Discuss with your provider transitioning to duloxetine or pregabalin—these are evidence-based, FDA-approved options
- Taper off sulindac gradually once an effective alternative is established
- Incorporate non-pharmacologic therapies (exercise, CBT) as these provide comparable or superior benefits to medications alone
The evidence is clear: continuing or increasing an ineffective medication that carries cardiovascular and GI risks makes no clinical sense when proven alternatives exist specifically for your condition.