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What is sulindac, and how does it work (mechanism of action)?
Sulindac is a nonsteroidal anti-inflammatory drug (NSAID) that is used for treating pain, fever, and inflammation. Other NSAIDs include ibuprofen (Motrin), indomethacin (Indocin), nabumetone (Relafen) as well as others. They work by reducing the levels of prostaglandins, chemicals that are produced by the body and are responsible for pain, fever, and inflammation. Sulindac blocks the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower concentrations of prostaglandins. As a consequence, inflammation, pain and fever are reduced. Sulindac was approved by the FDA in September 1978.
What brand names are available for sulindac?
Is sulindac available as a generic drug?
Do I need a prescription for sulindac?
What are the side effects of sulindac?
Most patients benefit from sulindac and other NSAIDs with few side effects. However, serious side effects can occur and generally tend to be dose related, that is, they occur more frequently with higher doses. Therefore, it is advisable to use the lowest effective dose to minimize side effects.
The most common side effects of sulindac involve the gastrointestinal system, and these are:
- ulcerations of the stomach and small intestine,
- abdominal pain,
- serious gastrointestinal bleeding, and
- liver toxicity.
Sometimes, ulceration of the stomach and bleeding can occur without any abdominal pain, and black tarry stools, weakness, and dizziness upon standing (orthostatic hypotension) may be the only signs of internal bleeding.
Other important side effects include:
Sulindac should be avoided by patients with a history of exacerbation of asthma, hives, or other allergic reactions to aspirin or other NSAIDs. Rare but severe allergic reactions have been reported in such individuals. It also should be avoided by patients with peptic ulcer disease or poor kidney function, since this medication can aggravate both conditions. Fluid retention, blood clots, heart attacks, hypertension, and heart failure have also been associated with the use of NSAIDs such as sulindac.
What is the dosage for sulindac?
The usual adult dose is 150 or 200 mg given twice daily with meals. The maximum dose is 400 mg daily.
Which drugs or supplements interact with sulindac?
Sulindac may reduce the blood pressure lowering effects of blood pressure medications. This may occur because prostaglandins have a role in the regulation (reduction) of blood pressure. Combining NSAIDs such as sulindac with angiotensin receptor blockers (for example, valsartan [Diovan], losartan [Cozaar], irbesartan [Avapro]) or angiotensin converting enzyme (ACE) inhibitors (for example, enalapril [Vasotec], captopril [Capoten]) in patients who are elderly, fluid-depleted (including those on diuretic therapy), or with poor kidney function may result in reduced kidney function, including kidney failure. These effects usually are reversible.
When sulindac is used in combination with methotrexate (Rheumatrex, Trexall) or aminoglycoside antibiotics (for example, gentamicin) the blood levels of methotrexate or aminoglycoside may increase, presumably because the elimination of methotrexate or aminoglycosides from the body is reduced. This may lead to more methotrexate or aminoglycoside-related side effects.
Individuals taking oral blood thinners or anticoagulants, for example, warfarin, (Coumadin), should avoid sulindac because sulindac also thins the blood, and excessive blood thinning may lead to bleeding.
Persons who consume more than three alcoholic beverages per day are at increased risk of developing stomach ulcers when taking sulindac or other NSAIDs.
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Is sulindac safe to take if I'm pregnant or breastfeeding?
It is not known whether sulindac is excreted in breast milk.
What else should I know about sulindac?
What preparations of sulindac are available?
tablets: 150 and 200 mg
How should I keep sulindac stored?
Sulndac should be stored in a sealed container and protected from moisture at room temperature, 15-30 C (59-86 F).
Sulindac (Clinoril) is a nonsteroidal antiinflammatory drug (NSAID) used for the treatment of pain, fever, swelling, inflammation, and tenderness in the joints caused by rheumatoid arthritis, tendinitis, bursitis, ankylosing spondylitis, gout, osteoarthritis. Side effects, warnings and precautions, drug interactions, and safety during pregnancy should be reviewed prior to taking this medication.
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Related Disease Conditions
Buildup of uric acid crystals in a joint causes gouty arthritis. Symptoms and signs include joint pain, swelling, heat, and redness, typically of a single joint. Gout may be treated with diet and lifestyle changes, as well as medication.
Bursitis of the hip results when the fluid-filled sac (bursa) near the hip becomes inflamed due to localized soft tissue trauma or strain. Symptoms include stiffness and pain around the hip joint. If the hip bursa is not infected, hip bursitis can be treated with ice compresses, rest, and anti-inflammatory and pain medications.
Rheumatoid Arthritis (RA)
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease. The 16 characteristic early RA signs and symptoms include the following. Anemia Both sides of the body affected (symmetric) Depression Fatigue Fever Joint deformity Joint pain Joint redness Joint stiffness Joint swelling Joint tenderness Joint warmth Limping Loss of joint function Loss of joint range of motion Many joints affected (polyarthritis)
Ankle Pain (Tendinitis)
Ankle pain is commonly due to a sprain or tendinitis. The severity of ankle sprains ranges from mild (which can resolve within 24 hours) to severe (which can require surgical repair). Tendinitis of the ankle can be caused by trauma or inflammation.
Lupus (Systemic Lupus Erythematosus or SLE)
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous system. When only the skin is involved, the condition is called discoid lupus. When internal organs are involved, the condition is called systemic lupus erythematosus (SLE).
Bursitis of the knee results when any of the three fluid-filled sacs (bursae) become inflamed due to injury or strain. Symptoms include pain, swelling, warmth, tenderness, and redness. Treatment of knee bursitis depends on whether infection is involved. If the knee bursa is not infected, knee bursitis may be treated with ice compresses, rest, and anti-inflammatory and pain medications.
Still's disease (systemic-onset juvenile rheumatoid arthritis) is a disorder characterized by inflammation with high fever spikes, fatigue, salmon-colored rash, and/or arthritis. Though there have been several theories regarding the cause(s) of Still's disease, the cause is not yet known. Many symptoms of Still's disease are often treatable with anti-inflammatory drugs.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited. Treatment incorporates medications, physical therapy, and exercise.
Shoulder bursitis is inflammation of the shoulder bursa. Bursitis may be caused by injury, infection, or a rheumatic condition. Symptoms include pain, swelling, tenderness, and pain with movement of the shoulder joint. Treatment may involve ice compresses, rest, and anti-inflammatory medications and depends on whether there is an infection.
A bursa is a fluid-filled sac found in the joints that cushions them. Bursitis is an inflammation of the bursae, most commonly caused by repetitive motion. Bursitis can be caused by a bacterial infection and should be treated with antibiotics. Doctors also recommend icing and resting the joint.
Osteoarthritis is a type of arthritis caused by inflammation, breakdown, and eventual loss of cartilage in the joints. Also known as degenerative arthritis, osteoarthritis can be caused by aging, heredity, and injury from trauma or disease.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms and signs include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves anti-inflammatory medications and exercise.
Nonsteroidal Anti-inflammatory Drugs and Ulcers
Nonsteroidal antiinflammatory drugs (NSAIDs) are prescribed medications for the treatment of inflammatory conditions. Examples of NSAIDs include aspirin, ibuprofen, naproxen, and more. One common side effect of NSAIDs is peptic ulcer (ulcers of the esophagus, stomach, or duodenum). Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking NSAIDs.
Reactive arthritis is a chronic, systemic rheumatic disease characterized by three conditions, including conjunctivitis, joint inflammation, and genital, urinary, or gastrointestinal system inflammation. Inflammation leads to pain, swelling, warmth, redness, and stiffness of the affected joints. Non-joint areas may experience irritation and pain. Treatment for reactive arthritis depends on which area of the body is affected. Joint inflammation is treated with anti-inflammatory medications.
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Medications & Supplements
- Nonsteroidal Antiinflammatory Drugs (NSAIDs)
- ibuprofen (Advil, Motrin, Nuprin)
- naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
- meloxicam (Mobic) Side Effects
- celecoxib (Celebrex)
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- indomethacin, Indocin, Indocin-SR (Discontinued Brand in U.S.)
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- etodolac, Lodine (Discontinued)
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- valdecoxib, Bextra
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Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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