What is the proper use of Sulindac (nonsteroidal anti-inflammatory drug)?

From the Guidelines

Sulindac should be used at the lowest effective dose for the shortest duration possible to minimize side effects, with a typical adult dosage of 150-200 mg twice daily, and a maximum recommended daily dose of 400 mg, as it carries cardiovascular and gastrointestinal risks like other NSAIDs, including increased risk of heart attack, stroke, and stomach bleeding, particularly with prolonged use or higher doses 1.

Key Considerations

• Sulindac is a nonsteroidal anti-inflammatory drug (NSAID) primarily used to treat pain, inflammation, and stiffness caused by conditions such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute gout, and acute shoulder pain.
• Patients should take sulindac with food or milk to reduce gastrointestinal irritation.
• Important precautions include avoiding use in patients with aspirin allergy, advanced kidney disease, or history of GI bleeding.
• Common side effects include stomach pain, heartburn, nausea, headache, and dizziness.

Recommendations

• The treatment target is elimination of inflammation and optimization of quality of life, and sulindac may be used to relieve musculoskeletal signs and symptoms 1.
• Non-steroidal anti-inflammatory drugs, including sulindac, are recommended as first-line drug treatment for patients with pain and stiffness, and continuous treatment with NSAID is preferred for patients with persistently active, symptomatic disease 1.
• Cardiovascular, gastrointestinal, and renal risks should be taken into account when prescribing NSAID, and the lowest effective dose should be used for the shortest duration possible to minimize side effects 1.

Risks and Precautions

• Sulindac carries cardiovascular and gastrointestinal risks like other NSAIDs, including increased risk of heart attack, stroke, and stomach bleeding, particularly with prolonged use or higher doses.
• The risk of GI complications, including bleeding, perforation, or obstruction, is increased with sulindac use, especially in patients with a history of previous peptic ulcer, advanced age, or concomitant use of corticosteroids, anticoagulants, or other NSAIDs 1.

From the Research

Proper Use of Sulindac

Sulindac is a nonsteroidal anti-inflammatory drug (NSAID) that produces its therapeutic activities through inhibition of cyclooxygenase (COX), the enzyme that makes prostaglandins (PGs) 2. The proper use of Sulindac involves:

• Using the lowest effective dose for the shortest possible time to minimize adverse effects 3
• Being aware of the potential gastrointestinal side effects, such as dyspepsia, ulcers, and bleeding 4, 5
• Considering the use of concomitant proton-pump inhibitors or misoprostol to prevent gastrointestinal ulcers 3
• Monitoring for cardiovascular risks, such as hypertension and acute renal failure 3

Adverse Effects

The adverse effects of Sulindac and other NSAIDs include:

• Gastrointestinal symptoms, such as dyspepsia, ulcers, and bleeding 4, 5
• Cardiovascular events, such as hypertension and acute renal failure 3
• Small intestinal inflammation, ulcers, and perforation 5
• Large intestinal ulcers, bleeding, and perforation 5

Special Considerations

Special considerations for the use of Sulindac include:

• Patients with a history of peptic ulcer disease or gastrointestinal bleeding should use Sulindac with caution 4, 3
• Patients with cardiovascular risk factors should be monitored closely for adverse effects 3
• Patients taking other NSAIDs or medications that increase the risk of gastrointestinal bleeding should use Sulindac with caution 4, 3