What to Know About Sulindac

Sulindac is a prescription nonsteroidal anti-inflammatory drug (NSAID) that comes as an oral tablet. It is used to treat pain, swelling, stiffness, and tenderness related to a variety of arthritis conditions in adults. It has also been used to treat bursitis and tendonitis.

Keep reading to learn about what sulindac is, its uses, side effects, dosages, warnings, and precautions.

Uses

Sulindac is a prodrug—a biologically inactive substance that is metabolized in the body to produce a drug. It is derived from a substance called sulfinylindene, which once in the body becomes an active nonsteroidal anti-inflammatory drug (NSAID).

Studies have found sulindac to be less irritating to the stomach than other NSAIDs, except for cyclooxygenase enzyme-2 (COX-2) inhibitors (such as Celebrex). The exact process of NSAIDs is unknown, but researchers believe these drugs act on COX-1 and COX-2 to inhibit prostaglandins.

Protaglandins promote pain, fever, and inflammation throughout the body. By blocking prostaglandins, pain, fever, and inflammation are reduced.

Sulindac is used to treat pain, redness, swelling, and inflammation from different types of arthritis.

Different arthritis conditions treated with sulindac include:

• Osteoarthritis: A wear-and-tear type of arthritis that causes a breakdown of the joints
• Rheumatoid arthritis: A type of arthritis in which an overactive immune system causes inflammation that attacks the lining of joints
• Ankylosing spondylitis: A type of inflammatory arthritis that affects the spine
• Gout: A type of arthritis that causes severe joint pain and swelling due to a buildup of uric acid in the body

Sulindac has also been prescribed to people with shoulder bursitis or tendonitis. Shoulder bursitis is inflammation of the fluid-filled sac in the shoulder joint. Tendonitis causes inflammation in the tissues that connect muscle to bone.

Off-Label Uses

Sulindac has been used off-label for treating a condition called familial adenomatous polyposis (FAP). FAP is an inherited disorder that predisposes a person to cancer. It leads to hundreds or thousands of precancerous polyps, especially in the colon.

An animal study reported in September 2020 looked at 7- to 8-week male and female mice that shared a genetic makeup related to human FAP syndrome. The mice were treated with sulindac, with and without phosphatidylcholine (PC), for three weeks.

Phosphatidylcholine is similar to the naturally occurring source of choline in the body. It has been used to treat a variety of conditions, including ulcerative colitis.

The study found that both sulindac and sulindac-PC treatments significantly reduced the number of polyps and decreased urinary prostaglandins. In addition, sulindac plus PC also resulted in a higher reduction of gastric (stomach) lesions compared with sulindac alone.

Before Taking

Sulindac is sometimes a first-line (initial) treatment for mild to moderate pain associated with arthritis conditions. It can relieve inflammation, swelling, stiffness, and joint pain. However, it is not a cure for any condition and will work only for as long as it is taken.

Sulindac is available only as a generic drug. A generic drug is designed to be the same as a brand-name drug, including its active ingredients, dosages and strength, safety, routes of administration, quality, performance, and uses. It was previously available under the brand name Clinoril, but Clinoril was discontinued or withdrawn by the drug's manufacturer.

Before prescribing sulindac, your healthcare provider will explain all the benefits and risks associated with its use. You and your practitioner will make the decision to start treatment with sulindac. To help with that decision, your healthcare provider will consider your other medical conditions and current treatments for those conditions, any allergies, your age, and your overall general health.

Precautions and Contraindications

Before starting sulindac, your healthcare provider needs to know if you have any allergy to the drug, aspirin, or another NSAID. You should also share with your practitioner your medical history, especially if you have a history of asthma or breathing problems after using aspirin or other NSAIDs. 

Other medical conditions your healthcare provider will need to know about include bleeding or clotting problems, nasal polyps, heart disease (e.g., heart attack), high blood pressure, kidney or liver disease, prior ulcers (stomach, intestinal, or esophageal), or bleeding, and history of stroke.

You should also let your practitioner know about all the medications you take, including prescription, over-the-counter (OTC) therapies, vitamins, and herbal supplements.

You should tell your healthcare provider if you are pregnant or planning to become pregnant. Sulindac and other NSAIDs might be harmful to an unborn baby and might cause problems during labor and delivery.

Most NSAIDs are not recommended for use in pregnancy from 20 weeks until delivery. If sulindac or another NSAID is needed during pregnancy, it should be used at the lowest possible dose and not after 30 weeks of pregnancy. Breastfeeding while using sulindac is not recommended.

Other NSAIDs

Sulindac belongs to a class of drugs called NSAIDs that work by stopping the body's production of substances that cause inflammation, pain, and fever. Other NSAID drugs used to treat arthritis, inflammation, and similar conditions include: 

• Celebrex (celecoxib)
• Ibuprofen
• Indomethacin
• Lodine (etodolac)
• Mobic (meloxicam)
• Naproxen
• Voltaren (diclofenac sodium)

Dosage

Sulindac is available as an oral tablet. Dosage is based on the condition being treated, its severity, your age, other conditions you have, and how you respond to the drug. It is generally prescribed as a 150 milligram (mg) or 200 mg tablet to be taken twice daily.

For some conditions, especially arthritis, it can take up to two weeks to feel the full effects of this drug. Sulindac should be taken regularly and provides symptom relief only while you are taking it. Its effects quit after you stop the drug. You can tell that sulindac is working because you will experience less pain from the condition it was prescribed to treat.

Sulindac is prescribed only to adults age 18 and over. Its labeling does not provide dosing information for children.

How to Take and Store

Sulindac should be taken with a full glass of water unless your healthcare provider provides you with different instructions. It can be taken with food, after a meal, or with an antacid (such as Tums) to reduce stomach discomfort.

If you stop taking the drug, you might not experience its full effects. If you miss doses or don’t take sulindac as scheduled, it may not work as well or it may stop working completely.

If you take too much, you could have dangerous levels of the drug in your body. Look out for signs of an overdose, including nausea, vomiting, dizziness, black or bloody stools, and coughing up blood.

If you miss a dose, and there are still more than a few hours before your next dose, go ahead and take your dose. However, if you are close to the time for your next dose, skip the dose, and take the next one at the usual time.

It is never a good idea to try to catch up and take two doses at once. This could cause serious or dangerous side effects.

You can store sulindac at room temperature in a sealed container away from light. Don’t store the drug in a moist or damp area, such as a bathroom.

Side Effects

Along with its desired effects, sulindac may also cause unwanted side effects. You may experience some or a lot of these. Some side effects might be more common, while others might be severe and require you to reach out to your healthcare provider.

Common Side Effects

More common side effects of sulindac are usually mild and may go away within a few days of using the drug. If they become severe or persistent, reach out to your healthcare provider.

Common side effects include:

• Gastrointestinal (GI) symptoms, including acid or sour stomach, stomach pain, heartburn, constipation, nausea, vomiting, and/or belching
• Headache
• Skin rash
• Dizziness

Severe Side Effects

You should call your healthcare provider right away if you experience serious side effects while using sulindac. Call 911 if you have side effects that are a sign of a medical emergency or that appear life-threatening.

Serious side effects might include:

• Chest pain or a heart attack: Symptoms might include chest pain or tightness, sweating, shortness of breath, arm pain, fatigue, and/or heartburn/indigestion.
• Stroke: Symptoms include weakness on one side of the body or slurred speech.
• Swelling in the arms and legs, hands and feet, or throat.
• Stomach bleeding or ulcers: Symptoms include vomiting blood, bloody stools, and black, sticky stools.
• Skin reactions: Symptoms include rash, inflamed skin, blisters, and itching.
• Liver problems: Symptoms include yellowing of skin or whites of the eyes.
• Asthma attacks: Symptoms include shortness of breath and/or trouble breathing.
• Allergic reaction: While rare, sulindac might cause an allergic reaction called anaphylaxis. This is more common in people who are allergic to aspirin or other NSAIDs.

There are other side effects not listed that may affect some patients. If you notice other effects, reach out to your healthcare provider.

Warnings and Interactions

Sulindac, much like other NSAIDs, comes with black box warnings for cardiovascular and GI events. Black box warnings alert the consumer and medical professionals about the worst possible effects of a drug.

Cardiovascular risk associated with sulindac and other NSAIDs increases with longer use. People with other risk factors for cardiovascular events include those with high blood pressure and diabetes, a family history of cardiovascular disease, and tobacco use.

NSAIDs may increase the risk of heart attack, stroke, or cardiovascular thrombotic (blood clotting) events, all of which can be fatal. NSAIDs should not be given to manage perioperative pain before, during, or following a coronary artery bypass graft (CABG) surgery as there might be an increased risk of heart attack or stroke.

Sulindac, like other NSAIDs, can increase the risk of GI events, including bleeding, ulcers, and stomach or intestinal tears, all events that can be fatal. GI events can occur at any time while using the drug and may occur without warning. Older adults have a higher risk for serious GI events associated with NSAID use.

If you are taking sulindac for long periods, your healthcare provider may want to monitor your kidneys and liver with blood work. Make sure you keep up with routine doctor visits and requests for lab work.

Summary

Sulindac is a prescription NSAID given for the pain and inflammation seen with arthritis and bursitis. It is available only as a generic drug. Common side effects include digestive tract symptoms. As an NSAID, there is also a risk of cardiovascular (heart and blood vessels) and digestive system events.