Sulindac (Oral)

Sulindac is an NSAID intended for the short or long-term relief of pain and inflammation produced by acute inflammatory disorders.

Overview

Sulindac is classified as a prescription-only nonsteroidal anti-inflammatory drug and is available under the U.S. trade name Clinoril. Doctors often prescribe this NSAID to help alleviate and manage mild to acute pain in patients diagnosed with arthritis and other inflammatory diseases, for instance.

Sulindac is generally one part of a holistic management plan for certain underlying conditions associated with joint pain and inflammation. The most popular include arthritis or gout, for example.

Top Benefits of Sulindac

Sulindac generally helps to alleviate a number of symptoms, including:

  • Pain
  • Swelling
  • Stiffness in the Joints
  • Tenderness

Top Conditions Treated:

  • Ankylosing Spondylitis
  • Bursitis
  • Gout
  • Osteoarthritis
  • Rheumatoid Arthritis
  • Tendonitis

Route of Administration

Sulindac is taken orally in tablet form. Sulindac is generally supplied in strengths of 200 mg in bottles containing 100 pills. The tablets are shaped like a hexagon and feature a bright yellow color with the following stamp: MSD 942.

Benefits to Osteoporosis Patients

Patients who are diagnosed with osteoarthritis may be prescribed Sulindac for its pain-relieving and anti-inflammatory qualities. In clinical trials conducted by the FDA, the general response to the drug includes reduced symptoms, including:

  • Increased Joint Mobility
  • Pain Relief at Both Daytime and Nighttime
  • Reduced Swelling and Muscle Stiffness

In osteoporosis cases, taking 200-400 mg of Sulindac each day is considered to be just as effective as taking 2400 to 4800 mg of aspirin on a daily basis.

Benefits to Rheumatoid Arthritis Patients

Based on assessments by patients and clinical researchers, Sulindac is considered to be useful for the treatment of rheumatoid arthritis because the medication:

  • Decreases Joint Pain
  • Improves Mobility
  • Increases Flexibility in the Wrist
  • Lowers Morning Stiffness

In rheumatoid arthritis cases, taking 300-400 mg of Sulindac each day is considered to be just as effective as taking 3600 to 4800 mg of aspirin on a daily basis.

Benefits to Ankylosing Spondylitis Patients

In general, Sulindac helps to reduce pain, tenderness, and spasms in the spine. Patients who take this NSAID typically report a good response, including:

  • Pain Relief
  • Improved Spinal Mobility

In ankylosing spondylitis cases, taking 200-400 mg of Sulindac each day is measured to be just as effective as taking 75 to 150 mg of Indomethacin on a daily basis. Additionally, taking 300-400 mg of Sulindac each day is considered to be just as effective as taking 400 to 600 mg of Phenylbutazone on a daily basis.

Other Sulindac Applications

In some cases, doctors may additionally prescribe Sulindac for treating polyps in the colon. It is widely believed that Sulindac features cancer-fighting properties. As a result, doctors may recommend this medicine for decreasing polyps or precancerous lesions in the colon, particularly in patients with a familial history of colon cancer.

There are many other applications for Sulindac that are not explored in this guide. For example, Sulindac is occasionally used for the treatment of preterm labor and Alzheimer's Disease. For the purposes of this article, however, the focus remains on Sulindac for acute inflammatory disorders.

Important:

It is imperative that patients note that Sulindac does not cure the underlying conditions it is used to treat. Instead, it provides effective relief of accompanying symptoms.

Condition(s) Treated?

  • Osteoarthritis
  • Rheumatoid Arthritis
  • Acute Gout
  • Inflammation
  • Swelling
  • Stiffness
  • Joint Pain
  • Ankylosing Spondylitis
  • Bursitis, Tendinitis

Type of Medicine?

  • Nonsteroidal Anti-Inflammatory Drug (NSAID)

Side Effects

Sulindac may cause a range of side effects, ranging from mild to severe.

Most Common Side Effects of Sulindac:

  • Burping
  • Feeling Nauseous
  • Heartburn
  • Pain in the Stomach
  • Skin Irritation
  • Upset Stomach

Less Common Side Effects of Sulindac:

  • Excess Gas
  • Inflammation
  • Pain in the Stomach
  • Weight Loss

Rare Side Effects of Sulindac

  • Acid Stomach
  • Appetite Changes
  • Bloody Stools
  • Burning Sensation in the Stomach
  • Changes in Urine Color
  • Dehydration
  • Enlarged Glands or Dilated Veins
  • Extreme Perspiration
  • Feeling Dizzy or Lightheaded
  • Fever or Chills
  • Flu-Like Symptoms
  • Hives and Rashes
  • Hypersensitivity to Sunlight
  • Incessant Ear Ringing or Pounding
  • Irregular Heartbeat
  • Jaundice
  • Lethargy
  • Mood Swings
  • Nosebleeds
  • Pain in the Eyes
  • Pain in the Legs or Lower Back
  • Pain in the Muscles or Joints
  • Painful Urination
  • Red Eyes
  • Seizures
  • Skin Discolorations
  • Skin Peeling
  • Swollen Eyelids or Face
  • Tingling or Numb Sensations
  • Trouble Breathing
  • Vision Changes

When to Get Medical Help

As Sulindac could cause serious and potentially fatal side effects, patients should use extra caution when taking this medicine - and also know when to call 911. Some of the top warning signs that emergency medical help is needed include when patient experiences:

  • Black or Clay-Colored Stools
  • Bleeding or Bruising
  • Bloody Urination or Bile
  • Difficulty Urinating
  • Extreme Pain in the Stomach
  • Extreme Tiredness
  • Fluctuations in Weight
  • Hearing or Vision Loss
  • Jaundice
  • Loss of Consciousness
  • Reduced Alertness
  • Skin Blistering or Peeling
  • Swollen Face and/or Joints

When to Consult a Primary Healthcare Provider

A number of side effects associated with Sulindac subside with time. Patients, however, should inform their medical provider if the following symptoms persist:

  • Appetite Loss
  • Changes in Vision or Hearing
  • Cramped or Stiff Muscles
  • Depression
  • Difficulty Focusing
  • Hair Loss
  • Illusions
  • Insomnia
  • Lethargy
  • Ringing Ears
  • Swollen or Red Joints
  • Tingling or Burning Sensations
  • Vaginal Discharge

Warning Signs of a Heart Attack

Patients, caregivers, and loved ones should note some of the serious side effects of Sulindac, including the increased risk of a heart attack. Some of the main symptoms that a heart attack is unfolding or about to happen include:

  • Chest Tightness or Pain
  • Inaudible Speech
  • Irregular Heartbeat
  • Muscle Weakness
  • Skin that is Warm to the Touch

If you experience any of these symptoms, discontinue the use of Sulindac and inform your medical provider right away.

Pancreatitis

Pancreatitis has been moreover reported in some patients taking Sulindac. The following warning signs should be noted:

  • Appetite Loss
  • Constipation
  • Dark Colored Urine
  • Distended Stomach
  • Fever
  • Heartburn
  • Jaundice
  • Stomach Pain

Meningitis

Some cautionary signs that meningitis is at play when taking Sulindac include:

  • A General Feeling of Sickness
  • Decreased Appetite
  • Extreme Sleepiness
  • Feeling Nauseous
  • Fever
  • Headache or Migraines
  • Loss of Focus or Clarity
  • Stiffness in the Neck

Dosage

Dosage requirements for Sulindac vary considerably from one patient to another. For one, the underlying condition for treatment plays a significant role in quantities prescribed and for how long it is prescribed.

Other variables that are put into consideration by a medical provider include the medication strength, as tablets are supplied in several tiers of strength. Patients' age and pain levels are also factored in when writing an order for the medicine.

The below table provides an estimate of what doctors generally recommend. Do not use these estimates as a reference or replacement of a written order given to you by a healthcare provider.

Sulindac Doses for Arthritis

The following average doses apply to both Osteoarthritis and Rheumatoid Arthritis.

  • Adults: 150 mg | 2x Daily (Max Dose 400 mg)
  • Children: Varies

Note: The dose is generally adjusted based on the patient's response. Follow-up appointments are required as a result.

Sulindac Doses for Acute Gout

  • Adults: 200 mg | 2x Daily (Max Dose 400 mg)
  • Children: Varies

Dosage Length: On average, the length of treatment is 7 days for Acute Gout.

Sulindac Doses for Acute Painful Shoulder

Otherwise known as Acute Subacromial Bursitis or Supraspinatus Tendinitis, the average dose for this condition is:

  • Adults: 200 mg | 2x Daily (Max Dose 400 mg)
  • Children: Varies

Dosage Length: On average, the length of treatment is 7-14 days.

Health Indexes Used for Dosage

Medical professionals use a number of health indexes to measure the level of pain experienced by patients diagnosed with acute inflammatory diseases in order to gauge the right dose for Sulindac. A few examples include:

  • The ARA Functional Class
  • The Proximal Interphalangeal Joint Size
  • The Ritchie Articular Index
  • The Schober Test
  • The Visual Analog Scale
  • The Wright Modification of the Schober Test

Proper Use

Most pharmacists and healthcare workers recommend taking Sulindac with a full meal to reduce the risks of unwanted side effects. In addition, Sulindac should be taken with a full glass of water for maximum effectiveness, in addition to preventing kidney issues.

Patients who have difficulty swallowing whole pills can generally cut up or crush Sulindac into food or water. However, speak with your pharmacist to confirm if this alternative is right for you.

Missed Dose

In the event of a missed dose, Sulindac should never be doubled. Typically, the medicine is prescribed in 12-hour intervals. Therefore, if you miss a dose, it is possible to take it as soon as you remember. However, if the time is getting close for the next dose, skip the missed dose and keep the normal schedule.

Fun Tip: Consider setting up an alarm to prevent incidences of missed doses.

Overdose

Some of the top warning signs of an overdose include:

  • Loss of Cognizance
  • Fainting or Dizzy Spells
  • Vision Changes
  • Extreme Pain the Stomach Decreased Urination

In the event of an overdose, contact the American Association of Poison Control Centers at (800) 222-1222 and/or call 911 immediately.

Interactions

Certain drugs are not recommended for simultaneous use with Sulindac, as doing so has been shown to cause negative side effects in patients.

When deemed medically necessary to prescribe both Sulindac and one of the below drugs for concurrent use, the medical provider may adjust the average dosage.

As a precaution however, the healthcare industry typically avoids prescribing Sulindac with any hundreds of medicines. In fact, more than 412 drugs have been found to interact negatively with Sulindace, with side effects ranging from mild to severe. Some of these negative drug interactions include but aren't limited to:

  • Acalabrutinib
  • Adefovir
  • Anisindione
  • Apixaban
  • Ardeparin
  • Balsalazide
  • Bemiparin
  • Benazepril
  • Bendroflumethiazide
  • Benzthiazide
  • Beta Glucan
  • Betamethasone
  • Betaxolol
  • Betrixaban
  • Bexarotene
  • Bisacodyl
  • Bismuth Subsalicylat
  • Botulism Immune Globulin
  • Cabozantinib
  • Cangrelor
  • Celecoxib
  • Cidofovir
  • Cytomegalovirus Immune Globulin
  • Dabigatran
  • Dalteparin
  • Danaparoid
  • Dasatinib
  • Deferasirox
  • Desipramine
  • Desirudin
  • Desirudin
  • Desmopressin
  • Diatrizoate
  • Drotrecogin Alfa
  • Edoxaban
  • Efavirenz
  • Emtricitabine
  • Enoxaparin
  • Eptifibatide
  • Escitalopram
  • Fondaparinux
  • Hyoscyamine
  • Ibritumomab
  • Ibrutinib
  • Imipramine
  • Immune Globulin Intravenous
  • Indapamide
  • Iodamide
  • Iodine I 131 Tositumomab
  • Iodipamide
  • Iodipamide
  • Iodixanol
  • Iohexol
  • Iopamidol
  • Iopromide
  • Iothalamate
  • Ioversol
  • Ioxaglate
  • Ioxilan
  • Ketoprofen
  • Ketorolac
  • Leflunomide
  • Lepirudin
  • Levomilnacipran
  • Lomitapide
  • Methenamine
  • Methotrexate
  • Methylene Blue
  • Metolazone
  • Milnacipran
  • Mipomersen
  • Morniflumate
  • Nabumetone
  • Nadroparin
  • Naproxen
  • Omacetaxine
  • Panobinostat
  • Phenindione
  • Phenprocoumon
  • Phenyl Salicylate
  • Phenyl Salicylate
  • Phenylbutazone
  • Piketoprofen
  • Piroxicam
  • Polythiazide
  • Ponatinib
  • Potassium
  • Prasugrel
  • Probenecid
  • Proglumetacin
  • Ramucirumab
  • Regorafenib
  • Respiratory Syncytial Virus Immune Globulin
  • Rivaroxaban
  • Sirolimus
  • Sodium Biphosphate
  • Sodium Biphosphate
  • Tacrolimus
  • Teriflunomide
  • Tinzaparin
  • Tositumomab
  • Vorapaxar
  • Warfarin

Drug Classes

In particular, it is imperative to disclose the use of the following classes of drugs before commencing treatment with Sulindac:

  • Angiotensin-Converting Enzyme (ACE) Inhibitors
  • Angiotensin II Receptor Blockers
  • Aspirin
  • Blood Thinners Or Anticoagulants
  • Corticosteroids
  • Diuretics
  • NSAIDS
  • Oral Steroids
  • Selective Serotonin Reuptake Inhibitors (SSRIS)
  • Serotonin Norepinephrine Reuptake Inhibitors (SNRIS)

Sulindac Interactions with NSAIDS

Nonsteroidal anti-inflammatory drugs (NSAIDs), when used in conjunction with Sulindac can lead to a number of serious conditions including:

  • High Blood Pressure
  • Edema
  • Fluid Retention

These include both prescription and non-prescription NSAIDs that can be taken orally or topically.

Advise your doctor if you use or plan on using any NSAIDs, as an adjusted dose may be needed before commencing treatment with Sulindac.

Sulindac Interactions with Alcohol

Patients should avoid alcohol use while taking Sulindac as this could increase the risks of serious negative side effects. The main concerns when alcohol is used simultaneously with Sulindac is stomach bleeds. This is a serious side effect and you should call 911 right away if you notice any signs of stomach bleedings, including blood stools and vomiting.

Sulindace Interactions with Non-Drugs

Over the counter medicines, including vitamins and herbal supplements may moreover cause negative interactions to occur. These include pain, allergy, or cold medicines, for example. If you take or plan on using any non-RX medicine, advise your doctor before using with Sulindac.

Warnings

Patients should be mindful of the following precautions as well as any others listed on prescription labels or inserts.

This article in no way represents the medical advice provided by your primary health care physician. If you have questions or concerns regarding the safety of Sulindac, schedule an appointment or phone call with your doctor or pharmacist.

Routine Check-Ups

To determine if Sulindac is working as it should, medical providers generally schedule routine checkups where a number of lab work is completed to test progress. Patients should make every effort to keep these appointments as scheduled in order to ensure that the current dosage is working in sync with present symptoms.

Routine checkups moreover help to prevent unwanted side effects associated with Sulindac.

Pre-Existing Medical Conditions

Using Sulindac could cause complications in patients who have pre-existing medical conditions, such as:

  • A History of Stroke
  • Asthma or Respiratory Issues
  • Bleeding Disorders
  • Fluid Retention
  • Heart Health Issues
  • High Blood Pressure
  • Kidney or Liver Disease
  • Lupus

It is consequently important for patients to disclose their full medical history before commencing Sulindac treatments. Doctors generally make a calculated decision based on benefits and risks and may adjust the average dose prescribed based on these and other underlying conditions.

Heart Disease

Individuals with heart disease are more susceptible to getting a heart attack or stroke while using Sulindac, particularly patients taking Sulindac for a long time.

Internal Bleeding

Using Sulindac could cause spontaneous internal bleeding, which means this could occur without warning. More specifically, someone with a history of the following conditions is generally described as being at a higher risk of internal bleeding:

  • Individuals Who Drink or Smoke
  • Seniors Over 65 Years of Age
  • Patients Who Have Ulcers
  • Individuals Using Blood Thinners or Steroids

Internal bleeding could be potentially fatal. As a result, patients should discuss the following with their primary healthcare physician:

  • The Full Medical History
  • All Medications Taken (Prescription and Non-Prescription)

Blood Pressure Screenings

As Sulindac could cause sudden increases in blood pressure, primary care physicians often tell patients to complete at-home screenings on a regular basis. If high readings are measured, a doctor should be consulted right away.

Routine In-Office Health Screens

Other health screens that are commonly performed with a Sulindac order, in addition to blood pressure checks, include:

  • A Complete Blood Count
  • Kidney Function Test
  • Liver Function Test

Allergies

Tell your doctor if you have a history of allergies to foods, dyes, preservatives, animal products or any other substances. Sulindac contains both active and inactive ingredients that could possibly trigger an allergic reaction. The trade name Clinoril is listed as having the following inactive ingredients:

  • Cellulose
  • Magnesium Stearate
  • Starch

Anaphylaxis Shock

If you have a history of allergies to aspirins or incidences of anaphylaxis shock, tell your doctor before taking Sulindac.

Anaphylaxis is considered to be a serious but rare and potentially fatal side effect of using Sulindac. As a result, if you notice any of the below symptoms, stop the treatment and call 911 immediately:

  • Changes in Skin Color
  • Fast Heartbeat
  • Feeling Lightheaded
  • Hives
  • Swollen Eyelids
  • Trouble Breathing
  • Wheezing

Skin Allergies

Sulindac could also cause serious skin allergies to occur. Be sure to seek emergency medical help if you experience:

  • Fevers or Chills
  • Peeling Skin
  • Severe Itching
  • Severe Lethargy
  • Skin Lesions

These may be signs of a severe allergic reaction that requires medical intervention.

Pregnant and Nursing Mothers

Sulindac is not recommended for expecting mothers as several studies have shown that it could harm an unborn fetus, particularly in the third trimester.

If you are pregnant or nursing, inform your doctor before starting Sulindac or any other prescribed treatments.

If you get pregnant while using Sulindac, inform your medical provider right away.

Prescription Instructions - Follow As Directed

For patients' safety, it is critical that all instructions are followed when taking Sulindac. Be sure to:

  1. Never Take More than the Ordered Dose of Sulindac
  2. Take the Number of Times Per Day Prescribed (Do Not Double Even if Pain Persists)
  3. Dispose of Unused Portions When the Treatment Length is Complete

These directives are particularly important in geriatric groups. Seniors may be more susceptible to the risk of side effects due to the presence of certain underlying conditions.

Best Practices for Taking Sulindac

To prevent health complications with the kidneys while taking Sulindac, drink copious amounts of water each day.

How Long Sulindac Takes to Work

In some cases, patients prescribed daily doses of Sulindac may not benefit from its pain-relieving effects for up to 7 days, and in extenuating circumstances, even longer.

For some patients who are diagnosed with acute arthritis, for example, it could take months to feel relief. If the results don't kick in as expected, continue the recommended dosage all the same. If you have concerns, consult your primary care physician for advice.

Storage

Sulindac should never be stored where children or pets have access to the medicine. Pharmacists recommend storing all medications in a high place or locked cabinet and keeping the American Poison Control Centers' number handy in the event of accidental dosage.

Moreover, to preserve the quality and effectiveness of Sulindac, be sure to store it in at a room temperature of 15-30ºC (59-86ºF). Avoid storing in direct sunlight or at extreme temperatures, such as in a freezer or near to heat, for example.

Disposal

Refer to the FDA's Disposal of Unused Medicines guide to find out more about best practices for discarding unused or expired portions of medicines.

The FDA advises against flushing or disposing of medicines in household trash. The endorsed way to discard of prescription drugs, including Sulindac, is via a take-back program at a local pharmacy in most cases.

Summary

Sulindac is renowned for its anti-inflammatory and pain-relieving effects in the healthcare industry. It is generally prescribed for arthritis, including osteoarthritis and rheumatoid arthritis as well as gout, ankylosing spondylitis, bursitis, and tendinitis.

This medicine could pose serious side effects, some potentially fatal. As a result, it is vital that patients take Sulindac exactly as prescribed. It is also important for patients to disclose their full medical history, including pre-existing conditions and any current medications. This helps primary health care providers weigh the risks and benefits - and ultimately prescribe the right dosage.

The average dose of Sulindac is 150-200 mg prescribed twice per day. In some cases, treatment lasts one to two weeks while in acute cases, the treatment may extend for years. In lengthy treatments of Sulindac, patients are carefully monitored to determine if any adjustments in dosage are required.

Patients who take Sulindac for longer stretches of time are typically at an increased risk of serious side effects, including heart attack, stroke, hypertension, edema, gastrointestinal bleeding. Severe skin allergies or anaphylaxis may also occur when taking Sulindac.

Patients using Sulindac for a prolonged period of time generally have routine in-office appointments scheduled in order for doctors to closely monitor progress and mitigate any negative side effects.

Moreover, certain pre-existing conditions, including asthma, and kidney, liver, or heart disease predispose patients to an increased risk of side effects. Periodic lab tests are necessary for these circumstances to lower Sulindac's risks.

Due to these possibilities, doctors generally prescribe the lowest dose for the shortest treatment length.

As an extra precaution, patients should know when to seek emergency help by recognizing certain symptoms. For example, if you have trouble breathing, an irregular heartbeat, vision loss, bloody stools, urination, or bile, these could be signs of a rare and fatal side effect. In these events, contact 911 right away.

Though this medicine comes with potentially rare and serious risks, the general patient response is that Sulindac is beneficial for analgesic and anti-inflammatory purposes. Patients who undergo this treatment for arthritis, for example, generally experience less pain, inflammation, and discomfort throughout the day.

Most notably, Sulindac is not a cure for the acute inflammatory diseases it is used to treat. Nevertheless, it helps patients experience a better quality of life and can be used concurrently with other holistic management programs prescribed for the treatment of arthritis.

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Last Reviewed:
December 22, 2017
Last Updated:
April 05, 2018