sulindac (Rx)

Brand and Other Names:Clinoril, Sulin
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 150mg
  • 200mg

Ankylosing Spondylitis, Osteoarthritis, Rheumatoid Arthritis

150-200 mg PO q12hr

No more than 400 mg

Use lowest effective dose for shortest possible duration

Shoulder Pain

200 mg PO q12hr for 7-14 days

Gout

200 mg PO q12hr for 7 days

Familial Adenomatous Polyposis (Off-label)

150-200 mg PO q12hr

Renal Impairment

Severe renal impairment: Not recommended; administer lower dose and monitor closely if administration necessary

Hepatic Impairment

Administer lower dose; discontinue if toxicity occurs

Administration

Take with food or 8-12 oz water to avoid GI effects

Other Indications & Uses

Bursitis/bursitis (shoulder), synovitis, tendonitis/tendonitis (shoulder), tenosynovitis

Safety & efficacy not established

Ankylosing spondylitis, osteoarthritis, rheumatoid arthritis

150-200 mg PO q12hr

No more than 400 mg

Use lowest effective dose for shortest possible duration

Shoulder Pain

200 mg PO q12hr for 7-14 days

Gout

200 mg PO q12hr for 7 days

Familial Adenomatous Polyposis (Off-label)

150-200 mg PO q12hr

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Interactions

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            Adverse Effects

            1-10%

            GI pain (10%)

            Constipation (3-9%)

            Diarrhea (3-9%)

            Dizziness (3-9%)

            Dyspepsia (3-9%)

            Headache (3-9%)

            Nausea (3-9%)

            Rash (3-9%)

            Abdominal cramps (1-3%)

            Anorexia (1-3%)

            Edema (1-3%)

            Nervousness (1-3%)

            Pruritus (1-3%)

            Tinnitus (1-3%)

            Vomiting (1-3%)

            <1%

            Hypersensitivity reactions (including anaphylaxis, angioedema, bronchospasm, dyspnea) Sulindac therapy should be discontinued & not reinstituted if unexplained fever or other evidence of hypersensitivity occurs

            Thrombocytopenia

            Ecchymosis

            Purpura

            Leukopenia

            Agranulocytosis

            Neutropenia

            Bone marrow depression

            CHF (<1%)

            Hematuria (<1%)

            Renal impairment (including renal failure)

            Interstitial nephritis

            Nephrotic syndrome

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            Warnings

            Black Box Warnings

            Cardiovascular Risk

            • NSAIDs may increase risk of serious cardiovascular thrombotic events, myocardial infarction (MI), & stroke, which can be fatal
            • Risk may increase with duration of use
            • Patients with risk factors for or existing cardiovascular disease may be at greater risk
            • NSAIDs are contraindicated for perioperative pain in the setting of coronary artery bypass graft (CABG) surgery (increased risk of MI & stroke)

            Gastrointestinal Risk

            • NSAIDs increase risk of serious GI adverse events including bleeding, ulceration, & perforation of the stomach or intestines, which can be fatal
            • GI adverse events may occur at any time during use & without warning symptoms
            • Elderly patients are at greater risk for serious GI events

            Contraindications

            Hypersensitivity to drug or excipients

            In the setting of CABG surgery

            History of asthma, urticaria, or any other type of reaction after taking aspirin or other NSAIDs

            Cautions

            Sulindac metabolites have been reported rarely as the major or a minor component in renal stones in association with other calculus components; the drug should be used with caution in patients with a history of renal lithiasis, and they should be kept well hydrated while receiving therapy

            Pancreatitis has been reported in patients receiving therapy; should pancreatitis be suspected, the drug should be discontinued and not restarted, supportive medical therapy instituted, and patient monitored closely with appropriate laboratory studies (eg, serum and urine amylase, amylase/creatinine clearance ratio, electrolytes, serum calcium, glucose, lipase, etc.); a search for other causes of pancreatitis as well as those conditions which mimic pancreatitis should be conducted

            Because of reports of adverse eye findings with non-steroidal anti-inflammatory agents, it is recommended that patients who develop eye complaints during treatment have ophthalmologic studies

            In patients with poor liver function, delayed, elevated and prolonged circulating levels of the sulfide and sulfone metabolites may occur; such patients should be monitored closely; a reduction of daily dosage may be required

            In patients with systemic lupus erythematosus (SLE) and mixed connective tissue disease, there may be an increased risk of aseptic meningitis

            Patients receiving corticosteroids

            • Sulindac cannot be expected to substitute for corticosteroids or to treat corticosteroid insufficiency; abrupt discontinuation of corticosteroids may lead to disease exacerbation
            • Patients on prolonged corticosteroid therapy should have their therapy tapered slowly if a decision is made to discontinue corticosteroids
            • The pharmacological activity of sulindac in reducing fever and inflammation may diminish the utility of these diagnostic signs in detecting complications of presumed noninfectious, painful conditions

            Cardiovascular effects

            • May increase risk of serious cardiovascular (CV) thrombotic events, myocardial infarction, and stroke, which can be fatal
            • Patients with known CV disease or risk factors for CV disease may be at greater risk; to minimize potential risk for an adverse CV event in patients treated with an NSAID, the lowest effective dose should be used for the shortest duration possible; physicians and patients should remain alert for the development of such events, even in absence of previous CV symptoms
            • Patients should be informed about signs and/or symptoms of serious CV events and steps to take if they occur; there is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious CV thrombotic events associated with NSAID use; the concurrent use of aspirin and an NSAID does increase risk of serious GI events

            Hypertension

            • NSAIDs can lead to new onset of hypertension or worsening of pre-existing hypertension, either of which may contribute to the increased incidence of CV events.
            • Use with caution in patients with hypertension
            • Closely monitor blood pressure during initiation and during therapy
            • Patients taking angiotensin converting enzyme (ACE) inhibitors, thiazides, or loop diuretics may have impaired response to these therapies when taking NSAIDs

            Gastrointestinal effects

            • Therapy can cause serious gastrointestinal (GI) adverse events including inflammation, bleeding, ulceration, and perforation of the stomach, small intestine, or large intestine, which can be fatal
            • These serious adverse events can occur at any time, with or without warning symptoms; these trends continue with longer duration of use, increasing the likelihood of developing a serious GI event at some time during the course of therapy; however, even short-term therapy is not without risk
            • NSAIDs should be prescribed with extreme caution in those with prior history of ulcer disease or gastrointestinal bleeding; patients with a prior history of peptic ulcer disease and/or gastrointestinal bleeding who use NSAIDs have a greater than 10-fold increased risk for developing a GI bleed compared to patients with neither of these risk factors
            • Other factors that increase the risk for GI bleeding in patients treated with NSAIDs include concomitant use of oral corticosteroids or anticoagulants, longer duration of NSAID therapy, smoking, use of alcohol, older age, and poor general health status
            • Most spontaneous reports of fatal GI events are in elderly or debilitated patients and therefore, special care should be taken in treating this population
            • To minimize the potential risk for an adverse GI event in patients treated with an NSAID, the lowest effective dose should be used for the shortest possible duration
            • Patients and physicians should remain alert for signs and symptoms of GI ulceration and bleeding during NSAID therapy and promptly initiate additional evaluation and treatment if a serious GI adverse event is suspected
            • This should include discontinuation of the NSAID until a serious GI adverse event is ruled out; for high risk patients, alternate therapies that do not involve NSAIDs should be considered

            Hepatic effects

            • In addition to hypersensitivity reactions involving liver, in some patients the findings are consistent with those of cholestatic hepatitis
            • As with other non-steroidal anti-inflammatory drugs, borderline elevation of one or more liver tests without any other signs and symptoms may occur in patients taking NSAIDs; these laboratory abnormalities may progress, may remain essentially unchanged, or may be transient with continued therapy
            • The SGPT (ALT) test is probably the most sensitive indicator of liver dysfunction; meaningful (3 times the upper limit of normal) elevations of SGPT or SGOT (AST) reported in clinical trials
            • Notable elevations of ALT or AST (approximately three or more times the upper limit of normal) reported; in addition, rare cases of severe hepatic reactions, including jaundice and fatal fulminant hepatitis, liver necrosis and hepatic failure, some of them with fatal outcomes reported
            • A patient with symptoms and/or signs suggesting liver dysfunction, or in whom an abnormal liver test has occurred, should be evaluated for evidence of development of a more severe hepatic reaction while on therapy
            • Although such reactions as described above are rare, if abnormal liver tests persist or worsen, if clinical signs and symptoms consistent with liver disease develop, or if systemic manifestations occur (eg, eosinophilia, rash, etc.), therapy should be discontinued
            • In clinical trials the use of doses of 600 mg/day has been associated with an increased incidence of mild liver test abnormalities

            Renal effects

            • Long-term administration of NSAIDs has resulted in renal papillary necrosis and other renal injury; renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion; in these patients, administration of a non-steroidal anti-inflammatory drug may cause a dose-dependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation
            • Patients at greatest risk of this reaction are those with impaired renal function, heart failure, liver dysfunction, those taking diuretics and ACE inhibitors, patients who are volume-depleted, and the elderly; discontinuation of NSAID therapy is usually followed by recovery to the pretreatment state
            • No information is available from controlled clinical studies regarding use in patients with advanced renal disease; therefore, treatment with sulindac is not recommended in these patients with advanced renal disease; If therapy must be initiated, close monitoring of the patient’s renal function advisable

            Anaphylactic reactions

            • As with other NSAIDs, anaphylactic/anaphylactoid reactions may occur in patients without known prior exposure to sulindac; therapy should not be given to patients with the aspirin triad; this symptom complex typically occurs in asthmatic patients who experience rhinitis with or without nasal polyps, or who exhibit severe, potentially fatal bronchospasm after taking aspirin or other NSAIDs
            • Emergency help should be sought in cases where an anaphylactic/anaphylactoid reaction occurs

            Heart failure risk

            • NSAIDS have the potential to trigger HF by prostaglandin inhibition that leads to sodium and water retention, increased systemic vascular resistance, and blunted response to diuretics
            • NSAIDS should be avoided or withdrawn whenever possible
            • Heart failure: risk is higher if you administer more than directed or for longer than directed
            • AHA/ACC Heart Failure Guidelines; Circulation. 2016; 134

            Skin and drug reactions with eosinophilia and systemic symptoms

            • NSAIDS cause serious skin adverse events such as exfoliative dermatitis, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), which can be fatal; these serious events may occur without warning
            • Patients should be informed about the signs and symptoms of serious skin manifestations and use of the drug should be discontinued at first appearance of skin rash or any other sign of hypersensitivity
            • Drug reaction with eosinophilia and systemic symptoms (DRESS) reported; some of these events have been fatal or life-threatening; DRESS typically, although not exclusively, presents with fever, rash, lymphadenopathy, and/or facial swelling
            • Other clinical manifestations may include hepatitis, nephritis, hematological abnormalities, myocarditis, or myositis; sometimes symptoms of DRESS may resemble an acute viral infection
            • Eosinophilia is often present; because this disorder is variable in its presentation, other organ systems not noted here may be involved
            • Early manifestations of hypersensitivity, such as fever or lymphadenopathy, may be present even though rash is not evident; if such signs or symptoms are present, discontinue therapy and evaluate the patient immediately

            Hematologic effects

            • Anemia is sometimes seen in patients receiving NSAIDs; this may be due to fluid retention, occult or gross GI blood loss, or an incompletely described effect upon erythropoiesis
            • Patients on long-term treatment with NSAIDs, should have their hemoglobin or hematocrit checked if they exhibit any signs or symptoms of anemia; NSAIDs inhibit platelet aggregation and have been shown to prolong bleeding time in some patients
            • Unlike aspirin, their effect on platelet function is quantitatively less, of shorter duration, and reversible; patients who may be adversely affected by alterations in platelet function, such as those with coagulation disorders or patients receiving anticoagulants, should be carefully monitored

            Preexisting asthma

            • Patients with asthma may have aspirin-sensitive asthma; the use of aspirin in patients with aspirin-sensitive asthma has been associated with severe bronchospasm which can be fatal
            • Since cross reactivity, including bronchospasm, between aspirin and other non-steroidal anti-inflammatory drugs has been reported in such aspirin-sensitive patients, sulindac should not be administered to patients with this form of aspirin sensitivity and should be used with caution in patients with preexisting asthma

            Drug interaction overview

            ·Drugs that interfere with hemostasis
            • Monitor for bleeding
            • Diclofenac and anticoagulants such as warfarin have a synergistic effect on bleeding. Use with anticoagulants have an increased risk of serious bleeding
            • Serotonin release by platelets plays an important role in hemostasis
            • Monitor for signs of bleeding in patients concomitantly using anticoagulants (eg, warfarin), antiplatelet agents (eg, aspirin), selective serotonin reuptake inhibitors, and serotonin norepinephrine reuptake inhibitors
            ·Salicylates
            • Not generally recommended
            • Diclofenac with other NSAIDs or salicylates (eg, diflunisal, salsalate) increases the risk of GI toxicity, with little or no increase in efficacy
            • ACE inhibitors, angiotensin receptor blockers (ARBs), beta-blockers H5
            • Monitor for signs of worsening renal function in high-risk patients (eg, elderly patients, volume depleted, renal impaired patients)
            • NSAIDs may diminish the antihypertensive effect of ACE inhibitors, ARBs, or beta-blockers
            ·Diuretics
            • Monitor patients to assure diuretic efficacy including antihypertensive effects
            • NSAIDs can reduce natriuretic effect of loop and thiazide diuretics
            ·Digoxin
            • Monitor serum digoxin level
            • Diclofenac can increase serum concentration and prolong half-life of digoxin
            ·Pemetrexed
            • Monitor for myelosuppression, renal, and GI toxicity during coadministration of NSAIDS with pemetrexed in renally impaired patients (CrCl 45-79 mL/min)
            • Avoid NSAIDs with short elimination half-lives (eg, diclofenac, indomethacin) for a period of 2 days before, the day of, and 2 days following administration of pemetrexed
            • Interrupt dosing of NSAIDs with longer half-lives (eg, meloxicam, nabumetone) for at least 5 days before, during, and 2 days following pemetrexed administration
            • Diclofenac may increase the risk of pemetrexed­-associated myelosuppression, renal, and GI toxicity
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            Pregnancy & Lactation

            Pregnancy Category: B; D if used for prolonged periods, or near term (may cause premature closure of ductus arteriosus)

            The Quebec Pregnancy Registry identified 4705 women who had spontaneous abortions by 20 weeks' gestation; each case was matched to 10 control subjects (n=47,050) who had not had spontaneous abortions; exposure to nonaspirin NSAIDs during pregnancy was documented in approximately 7.5% of cases of spontaneous abortions and in approximately 2.6% of controls. (CMAJ, September 6, 2011; DOI:10.1503/cmaj.110454)

            Lactation: not known if distributed in milk

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Inhibits synthesis of prostaglandins in body tissues by inhibiting at least 2 cyclooxygenase isoenzymes, cyclooxygenase-1 (COX-1) and -2 (COX-2)

            May inhibit chemotaxis, may alter lymphocyte activity, decrease proinflammatory cytokine activity, and may inhibit neutrophil aggregation. These effects may contribute to its anti-inflammatory activity

            Pharmacokinetics

            Half-life: Sulindac (8 hr); sulfide metabolite (16.4 hr)

            Peak Plasma Time: 2 hr (sulindac); 5-6 hr (sulfide metabolites)

            Concentration: 3-6 mcg/mL

            Excretion: Urine (50%); feces (25%)

            Bioavailability: 90%

            Protein Bound: Approx 93% (sulindac); approx 98% (sulfide metabolite)

            Metabolism: Hepatic reduction; significant enterohepatic circulation

            Metabolites: Sulfide and sulfone metabolites

            Dialyzable: Unknown

            Enzymes inhibited: Cyclooxygenase

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            sulindac oral
            -
            200 mg tablet
            sulindac oral
            -
            200 mg tablet
            sulindac oral
            -
            200 mg tablet
            sulindac oral
            -
            150 mg tablet
            sulindac oral
            -
            200 mg tablet
            sulindac oral
            -
            150 mg tablet
            sulindac oral
            -
            150 mg tablet
            sulindac oral
            -
            150 mg tablet

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            sulindac oral

            SULINDAC - ORAL

            (SUL-in-dak)

            COMMON BRAND NAME(S): Clinoril

            WARNING: Nonsteroidal anti-inflammatory drugs (including sulindac) may rarely increase the risk of a heart attack or stroke. This effect can happen at any time while taking this drug but is more likely if you take it for a long time. The risk may be greater in older adults or if you have heart disease or increased risk for heart disease (for example, due to smoking, family history of heart disease, or conditions such as high blood pressure or diabetes). Do not take this drug right before or after heart bypass surgery (CABG).Also, this drug may rarely cause serious (rarely fatal) bleeding from the stomach or intestines. This effect can occur without warning symptoms at any time while taking this drug. Older adults may be at higher risk for this effect.Stop taking sulindac and get medical help right away if you notice any of these rare but serious side effects: stomach/abdominal pain that doesn't go away, black/tarry stools, vomit that looks like coffee grounds, chest/jaw/left arm pain, shortness of breath, unusual sweating, confusion, weakness on one side of the body, trouble speaking, sudden vision changes.Talk to your doctor or pharmacist about the benefits and risks of taking this drug.

            USES: See also Warning section.Sulindac is used to reduce pain, swelling, and joint stiffness from arthritis. It is also used to treat arthritis of the spine, gouty arthritis, and shoulder bursitis/tendonitis.Sulindac is known as a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking your body's production of certain natural substances that cause inflammation. This effect helps to decrease swelling, pain, or fever.If you are treating a chronic condition such as arthritis, ask your doctor about non-drug treatments and/or using other medications to treat your pain.

            HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking sulindac and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth as directed by your doctor, usually twice daily. Take this medication with a full glass of water (8 ounces/240 milliliters), unless your doctor directs you otherwise. Do not lie down for at least 10 minutes after taking this medication. If stomach upset occurs while taking this medication, take it with food, milk, or an antacid.The dosage is based on your medical condition and response to treatment. To reduce your risk of stomach bleeding and other side effects, take this medication at the lowest effective dose for the shortest possible time. Do not increase your dose or take this drug more often or for longer than prescribed. Discuss the risks and benefits with your doctor or pharmacist.For certain conditions (such as arthritis), it may take 1-2 weeks of taking this drug regularly until you get the full benefit.If you are taking this drug "as needed" (not on a regular schedule), remember that pain medications work best if they are used as the first signs of pain occur. If you wait until the pain has worsened, the medicine may not work as well.Tell your doctor if your condition gets worse.

            SIDE EFFECTS: See also Warning section.Upset stomach, nausea, vomiting, gas, diarrhea, constipation, dizziness, or headache may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.Tell your doctor right away if you have any serious side effects, including: hearing changes (such as ringing in the ears), mental/mood changes, easy bleeding/bruising, difficult/painful swallowing, symptoms of heart failure (such as swelling ankles/feet, unusual tiredness, unusual/sudden weight gain).Get medical help right away if you have any very serious side effects, including: signs of kidney problems (such as change in the amount of urine, pink/bloody urine), unexplained stiff neck.Sulindac may rarely cause serious (possibly fatal) liver disease. Get medical help right away if you have any symptoms of liver damage, such as: nausea/vomiting that doesn't stop, loss of appetite, stomach/abdominal pain, yellowing eyes/skin, dark urine.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: See also Warning section.Before taking sulindac, tell your doctor or pharmacist if you are allergic to it; or to aspirin or other NSAIDs (such as ibuprofen, naproxen, celecoxib); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: asthma (including a history of worsening breathing after taking aspirin or other NSAIDs), blood disorders (such as anemia, bleeding/clotting problems), growths in the nose (nasal polyps), heart disease (such as previous heart attack), high blood pressure, kidney stones, liver disease, stroke, swelling (edema, fluid retention), stomach/intestinal/esophagus problems (such as bleeding, heartburn, ulcers).Kidney problems can sometimes occur with the use of NSAID medications, including sulindac. Problems are more likely to occur if you are dehydrated, have heart failure or kidney disease, are an older adult, or if you take certain medications (see also Drug Interactions section). Drink plenty of fluids as directed by your doctor to prevent dehydration and tell your doctor right away if you have pink/bloody urine or any unusual change in the amount of urine.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).This medicine may cause stomach bleeding. Daily use of alcohol and tobacco, especially when combined with this medicine, may increase your risk for stomach bleeding. Limit alcohol and stop smoking.This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be at greater risk for stomach/intestinal bleeding, kidney problems, heart attack, and stroke while using this drug.Before using this medication, women of childbearing age should talk with their doctor(s) about the benefits and risks. Tell your doctor if you are pregnant or if you plan to become pregnant. This medication may harm an unborn baby and cause problems with normal labor/delivery. It is not recommended for use in pregnancy from 20 weeks until delivery. If your doctor decides that you need to use this medication between 20 and 30 weeks of pregnancy, you should use the lowest effective dose for the shortest possible time. You should not use this medication after 30 weeks of pregnancy.It is unknown if this medication passes into breast milk. Breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: aliskiren, ACE inhibitors (such as benazepril, lisinopril), angiotensin II receptor blockers (such as losartan, valsartan), cidofovir, corticosteroids (such as dexamethasone, prednisone), dimethyl sulfoxide (DMSO), lithium, methotrexate, "water pills" (diuretics such as furosemide).This medication may increase the risk of bleeding when taken with other drugs that also may cause bleeding. Examples include anti-platelet drugs such as clopidogrel, "blood thinners" such as dabigatran/enoxaparin/warfarin, among others.Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (aspirin, NSAIDs such as ibuprofen, ketorolac, naproxen). These drugs are similar to sulindac and may increase your risk of side effects if taken together. However, if your doctor has directed you to take low-dose aspirin to prevent heart attack or stroke (usually 81-162 milligrams a day), you should keep taking the aspirin unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe stomach pain, slow/shallow breathing, extreme drowsiness, loss of consciousness.

            NOTES: Do not share this medication with others.Lab and/or medical tests (such as complete blood count, liver/kidney function, blood pressure) may be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.Lifestyle changes (such as weight loss if needed, strengthening/conditioning exercises) may help improve your flexibility and joint function. Consult your doctor for specific instructions.

            MISSED DOSE: If you are prescribed this drug on a regular schedule (not just "as needed") and you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            Information last revised August 2022. Copyright(c) 2022 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.