Pregnancy Risk Category NR
How supplied
Tablets: 100 mg‡, 150 mg, 200 mg
Action
Produces anti-inflammatory, analgesic, and antipyretic effects, possibly by inhibiting prostaglandin synthesis.
Indications & dosage
Osteoarthritis, rheumatoid arthritis, ankylosing spondylitis--
Adults: initially, 150 mg P.O. b.i.d.; increased to 200 mg b.i.d., p.r.n. Maximum dose is 400 mg daily.
Acute subacromial bursitis or supraspinatus tendinitis, acute gouty arthritis--
Adults: 200 mg P.O. b.i.d. for 7 to 14 days. Dosage reduced as symptoms subside. Maximum dose is 400 mg daily.
Adverse reactions
CNS: dizziness, headache, nervousness, psychosis.
CV: hypertension, heart failure, palpitations, edema.
EENT: tinnitus, transient visual disturbances.
GI: epigastric distress, peptic ulceration, occult blood loss, nausea, constipation, dyspepsia, flatulence, anorexia, GI bleeding.
GU: interstitial nephritis, increased BUN and serum creatinine levels.
Hematologic: prolonged bleeding time.
Hepatic: increased serum alkaline phosphatase and transaminase levels.
Metabolic: hyperkalemia.
Skin: rash, pruritus.
Other: drug fever, anaphylaxis, angioedema, hypersensitivity syndrome.
Interactions
Drug-drug. Anticoagulants: increased risk of bleeding. Monitor PT and INR closely.
Aspirin: decreased sulindac plasma level and increased risk of GI adverse reactions. Don't use together.
Cyclosporine: increased nephrotoxicity of cyclosporine. Avoid concomitant use.
Diflunisal, dimethyl sulfoxide: decreased metabolism of sulindac to its active metabolite, reducing its effectiveness. Don't use together.
Methotrexate: increased methotrexate toxicity. Avoid concomitant use.
Sulfonamides, sulfonylureas, other highly protein-bound drugs: possible displacement of these drugs from plasma protein-binding sites, leading to increased toxicity. Monitor closely.
Probenecid: increased plasma levels of sulindac and its active metabolite. Monitor for toxicity.
Effects on diagnostic tests
None reported.
Contraindications
Contraindicated in patients with hypersensitivity to drug and in those in whom acute asthmatic attacks, urticaria, or rhinitis is precipitated by aspirin or NSAIDs.
Nursing considerations
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING