SULINDAC

SULINDAC (sul-in'dak) Clinoril Classifications: analgesic, nonsteroidal antiinflammatory drug (nsaid); antipyretic; Therapeutic: nsaid, analgesic; antipyretic Prototype: Ibuprofen Pregnancy Category: B (D in third trimester)

Availability

150 mg, 200 mg tablets

Action

Mechanism of antiinflammatory action thought to result from inhibition of prostaglandin synthesis. Comparable to aspirin in antiinflammatory activity with longer half-life.

Therapeutic Effect

Exhibits antiinflammatory, analgesic, and antipyretic properties.

Uses

Acute and long-term symptomatic treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis; acute painful shoulder (acute subacromial bursitis or supraspinatus tendinitis); acute gouty arthritis.

Contraindications

Hypersensitivity to sulindac; hypersensitivity to aspirin (patients with "aspirin triad": acute asthma, rhinitis, nasal polyps), other NSAIDs, or salicylates; significant kidney or liver dysfunction; CABG perioperative pain; pregnancy (category B; category D in third trimester), lactation. Safety in children is not established.

Cautious Use

History of upper GI tract disorders; anticoagulant therapy; CHF; moderate or mild renal impairment; compromised cardiac function, hypertension, hemophilia or other bleeding tendencies.

Route & Dosage

Arthritis, Ankylosing Spondylitis, Acute Gouty Arthritis Adult: PO 150–200 mg b.i.d. (max: 400 mg/d)

Administration

Oral

• Crush and give mixed with liquid or food if patient cannot swallow tablet.
• Administer with food, milk, or antacid (if prescribed) to reduce possibility of GI upset. Note: Food retards absorption and delays and lowers peak concentrations.

Adverse Effects (≥1%)

CNS: Drowsiness, dizziness, headache, anxiety, nervousness. CV: Palpitation, peripheral edema, CHF, (patients with marginal cardiac function). Special Senses: Blurred vision, amblyopia, vertigo, tinnitus, decreased hearing. GI: Abdominal pain, dyspepsia, nausea, vomiting, constipation, diarrhea, ulceration, flatulence, anorexia; stomatitis, sore or dry mucous membranes, dry mouth; GI bleeding, gastritis. Hematologic: Prolonged bleeding time, aplastic anemia, thrombocytopenia, leukopenia, eosinophilia. Body as a Whole: Angioneurotic edema, fever, chills, anaphylaxis. Skin: Stevens-Johnson syndrome, toxic epidermal necrolysis syndrome, rash, pruritus. Urogenital: Renal impairment.

Diagnostic Test Interference

Abnormalities in liver function tests may occur.

Interactions

Drug: Heparin, oral anticoagulants may prolong bleeding time; may increase lithium toxicity; aspirin, other nsaids add to ulcerogenic effects; may increase methotrexate toxicity; dimethylsulfoxide (DMSO) may decrease effects of sulindac. Herbal: Feverfew, garlic, ginger, ginkgo may increase bleeding potential.

Pharmacokinetics

Absorption: 90% from GI tract. Peak: 2 h without food, 3–4 h with food. Duration: 10–12 h. Distribution: Minimal passage across placenta; distributed into breast milk. Metabolism: In liver to active sulfide metabolite. Elimination: 75% in urine, 25% in feces. Half-Life: 7.8 h sulindac, 16.4 h sulfide metabolite.

Nursing Implications

Assessment & Drug Effects

• Lab tests: Obtain baseline and periodic evaluations of Hgb, kidney and liver function.
• Schedule auditory and ophthalmic examinations in patients receiving prolonged or high-dose therapy.
• Recommend an ophthalmoscopic examination if patient has eye complaints.

Patient & Family Education

• Do not drive or engage in potentially hazardous activities until response to drug is known.
• Report any incidence of unexplained bleeding or bruising immediately to physician (e.g., bleeding gums, black and tarry stools, coffee-colored emesis).
• Report onset of skin rash, itching, hives, jaundice, swelling of feet or hands, sore throat or mouth, shortness of breath, or night cough to physician.
• Be aware that adverse GI effects are relatively common. Report abdominal pain, nausea, dyspepsia, diarrhea, or constipation.
• Note: Initial effect may take up to 7 d; peak effect is usually experienced in 2–3 wk (relief of joint pain and stiffness, reduction in joint swelling, increase in grip strength, and improved mobility).
• Avoid alcohol and aspirin as they may increase risk of GI ulceration and bleeding tendencies.
• Inform dentist or surgeon of drug regimen because bleeding time may be prolonged.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug