Indications:

Sulindac is prescribed for managing a variety of arthritic conditions, including:

• Rheumatoid arthritis
• Osteoarthritis
• Acute gouty arthritis
• Ankylosing spondylitis
• Acute painful shoulder

How to Take:

• It should be taken with food to reduce stomach upset.

Dosage:

Adults:

• Ankylosing Spondylitis, Osteoarthritis, Rheumatoid Arthritis:
  • Typical dose: 150 mg twice daily (bid).
  • Maximum: 400 mg per day.
• Acute Painful Shoulder & Acute Gouty Arthritis:
  • Starting dose: 200 mg bid.
  • Dose adjustment is based on response; the typical treatment duration is 7-14 days.
  • Maximum: 400 mg per day.

Special Populations:

• Hepatic Impairment: Dosage reduction may be necessary.
• Renal Impairment: Dosage reduction is advised; not recommended in severe cases.

Contraindications:

• Hypersensitivity to sulindac.
• Use in the third trimester of pregnancy.
• Patients undergoing heart surgery (CABG).

Mechanism of Action:

• Sulindac acts as a prodrug, converted in the body to active metabolites that inhibit enzymes involved in inflammation.

Precautions:

• Use the lowest effective dose for the shortest possible time.
• Be cautious in patients with existing heart, kidney, or liver issues, and in those using other medications like aspirin or blood thinners.
• Increased risk of gastrointestinal and cardiovascular adverse effects.

Side Effects:

Common (1-10% incidence):

• Gastrointestinal pain, constipation, diarrhea, dizziness, headaches, nausea, rash, and other mild reactions.

Less Common (<1% incidence):

• Severe reactions include liver damage, kidney impairment, and potentially fatal skin reactions.

Pregnancy and Lactation:

• Category C generally, but Category D during the third trimester due to potential harm to the developing fetus.

Drug Interactions:

• Possible interactions include increased risk of nerve damage with dimethyl sulfoxide, enhanced toxicity when combined with drugs like ciclosporin or methotrexate and reduced effectiveness of blood pressure medications.

Quick Tips:

• Always take with food to minimize gastrointestinal discomfort.
• Monitor for signs of serious side effects, particularly in long-term use.
• Discuss any concurrent medication use with your healthcare provider to avoid harmful interactions.

This summary provides a comprehensive view of sulindac's uses, dosages, and safety information to help in effective and safe medication management.

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