Sulindac Dosing Guidelines
The recommended dosage for Sulindac is 150 mg twice daily with food, with a maximum dosage of 400 mg per day. 1
Standard Dosing for Different Conditions
Osteoarthritis, Rheumatoid Arthritis, and Ankylosing Spondylitis
- Initial dose: 150 mg twice daily with food 1
- Dose may be adjusted based on patient response
- Typical effective range: 200-400 mg daily 1
- A prompt response (within one week) can be expected in about half of patients 1
Acute Painful Shoulder (Acute Subacromial Bursitis/Supraspinatus Tendinitis)
- Recommended dose: 200 mg twice daily with food 1
- Duration: 7-14 days is usually adequate 1
- After satisfactory response, dosage may be reduced according to response 1
Acute Gouty Arthritis
- Recommended dose: 200 mg twice daily with food 1
- Duration: 7 days is usually adequate 1
- After satisfactory response, dosage may be reduced according to response 1
- FDA-approved for acute gout treatment 2
Dosing Considerations and Adjustments
Renal Impairment
- Since Sulindac is eliminated primarily by the kidneys, patients with significantly impaired renal function should be closely monitored 1
- A lower daily dosage should be anticipated to avoid excessive drug accumulation 1
Hepatic Impairment
- Patients with acute and chronic hepatic disease may require reduced doses compared to patients with normal hepatic function 1
- Hepatic metabolism is an important elimination pathway for Sulindac 1
Elderly Patients
- No specific dose adjustment is recommended based solely on age
- However, due to potential for decreased renal function in elderly patients, closer monitoring may be warranted 1
Safety Considerations
Maximum Dose
Administration
- Sulindac should be administered orally twice a day with food 1
- Taking with food helps minimize gastrointestinal side effects
Adverse Effects
- Higher doses (600 mg daily) have shown no additional efficacy over 400 mg daily but increased adverse reactions, particularly gastrointestinal and blood chemistry abnormalities 3
- Sulindac is generally better tolerated than aspirin, with lower incidence of total adverse effects, milder gastrointestinal reactions, and less tinnitus 1
Monitoring
- After observing the response to initial therapy, the dose and frequency should be adjusted to suit individual patient needs 1
- Use the lowest effective dose for the shortest duration consistent with treatment goals 1
- Monitor renal function in patients with impaired renal function 1
Common Pitfalls and Caveats
- Avoid exceeding the maximum daily dose of 400 mg, as higher doses increase adverse effects without improving efficacy 1, 3
- Do not use in patients with severe renal impairment without close monitoring and dose adjustment 1
- NSAIDs including Sulindac may increase risk of cardiovascular events and GI bleeding, especially with prolonged use or higher doses 2
- Consider gastroprotection with a proton pump inhibitor in patients at high risk for GI complications 2