Sulindac belongs to the class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). It is used to relieve mild to moderately severe pain accompanied by inflammation. It can be used to relieve pain in conditions such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, arthritis caused by gout, and shoulder pain due to bursitis or tendinitis.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The recommended dose of sulindac ranges from 300 mg to 400 mg daily in 2 divided doses, taken with food or milk. Once your condition improves, your doctor may recommend a lower dose.

Do not take this medication more often or for a longer period of time than as prescribed by your doctor.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from moisture, and keep it out of the reach of children.

Sulindac should not be taken by anyone who:

• is allergic to sulindac or to any of the ingredients of the medication
• is breast-feeding
• is under 12 years of age
• has a history of significantly impaired kidney function
• has or has recently had an inflammatory disease of the stomach and intestines such as stomach or intestinal ulcer, or ulcerative colitis
• is allergic to ASA or other NSAIDs (e.g., ibuprofen, ketorolac, diclofenac) or have had allergic symptoms (e.g., runny nose; asthma; itchy skin rash; nasal polyps; swelling of the face, throat, or tongue) caused by these medications
• is in the third trimester (last 3 months) of pregnancy
• has a bleeding disorder
• has bleeding in the brain
• has high levels of blood potassium (hyperkalemia)
• has inflammatory bowel disease (e.g., ulcerative colitis, Crohn's disease)
• has severely reduced liver function or liver disease
• has severe, uncontrolled heart failure
• has recently had coronary artery bypass surgery

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abdominal or stomach cramps, pain, or discomfort (mild to moderate)
• changed sense of taste
• constipation
• diarrhea
• dizziness, lightheadedness
• dry mouth
• hair loss
• headache (mild to moderate)
• heartburn
• menstrual problems
• nausea
• sweating
• thirst
• vomiting

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• bladder pain
• bleeding or crusting sores on lips
• bloody or cloudy urine or any problem with urination, such as difficult, burning, or painful urination
• burning feeling in throat, chest, or stomach
• confusion
• forgetfulness
• decreased hearing, any other change in hearing, or ringing or buzzing in ears
• high blood pressure (e.g., fatigue, dizziness, fainting, chest pain)
• muscle cramps, pain, or weakness
• nervousness
• numbness, tingling, or burning sensation in hands or feet
• pain in lower back or side (severe)
• signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
• signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)
• signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
• signs of heart failure (e.g., shortness of breath, fatigue, swelling in legs, ankles, feet, rapid weight gain)
• signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
• signs of stomach problems (dizziness, difficulty swallowing, stomach pain, loss of appetite, weight loss, nausea, vomiting, constipation or diarrhea, chills or fever)
• skin rash
• unusually heavy vaginal bleeding

Stop taking the medication and seek immediate medical attention if any of the following occur:

• abdominal or stomach pain, cramping, or burning (severe)
• hive-like swellings (large) on face, eyelids, mouth, lips, or tongue
• hives, itching of skin, or any other skin problem, such as blisters, redness or other colour change, tenderness, burning, peeling, thickening, scaliness, or loosening or splitting of fingernails
• nausea, heartburn, or indigestion (severe and continuing)
• shortness of breath, troubled breathing, wheezing, or tightness in chest
• signs of bleeding in the stomach (e.g., bloody, black, or tarry stools, spitting up of blood, vomiting blood or material that looks like coffee grounds)
• signs of meningitis not caused by infection (e.g., headache [severe], throbbing, or with stiff neck or back)
• signs of a heart attack (e.g., chest pain or pressure, pain extending through shoulder and arm, nausea and vomiting, sweating)
• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• signs of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Allergic reactions: If you have had a reaction to acetylsalicylic acid (ASA) or other NSAIDs (e.g., ibuprofen, ketoprofen, ketorolac) that included a runny nose, itchy skin rash, nasal polyps, or shortness of breath and wheezing, you should not take this medication. If you experience symptoms of a severe allergic reaction (e.g., hives; difficulty breathing; wheezing; swelling of the face, tongue, or throat), get immediate medical attention.

In rare cases, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS syndrome) may occur. This reaction involves symptoms including fever, swollen glands, yellowing of the skin or eyes, flu-like symptoms with skin rash or blistering, or other organ involvement. These reactions are medical emergencies. Get immediate medical attention if you have symptoms of a severe allergic reaction. If you experience any unusual symptoms, contact your doctor.

Bladder problems: This medication may cause bladder pain, painful or difficult urination, or increased frequency of urination. If these symptoms occur without an explanation (e.g., infection), stop taking this medication and contact your doctor.

Blood clotting: As with other NSAIDs, sulindac may reduce the ability of the blood to clot. If you are taking anticoagulants (e.g., warfarin, heparin), or have hemophilia or other blood disorders (e.g., low platelets), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you have a bleeding disorder, do not take this medication.

Drowsiness/reduced alertness: Some people have reported headache, dizziness, lightheadedness, and confusion while taking this medication. Avoid operating motor vehicles and doing other potentially hazardous activities until you have determined the effect this medication has on you.

Fluid and electrolyte balance: As with many other nonsteroidal anti-inflammatory drugs (NSAIDs), fluid retention and edema have been reported with use of this medication. People with the following medical conditions should be closely monitored by their doctor while taking sulindac:

• any other condition that might lead to fluid retention
• certain heart conditions
• high blood pressure
• kidney disease
• recovering from surgical operations under general anesthesia

Heart problems: NSAID medications may increase the risk of heart attacks, strokes, and blood clots. The risk is greater with higher doses and long-term use. People at risk of heart problems, such as those with high blood pressure, high cholesterol, diabetes, peripheral arterial disease, heart failure, or coronary artery disease, should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Infection: This medication may mask the signs of an infection, such as a fever.

Kidney function: The kidneys are involved in removing sulindac from the body. People with reduced kidney function may experience increased side effects of sulindac as a result of it not being removed as quickly as expected. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Decreased liver function or liver disease can cause this medication to build up in the body causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Potassium: There is a risk of high blood potassium with the use of sulindac. People most at risk are seniors, those having conditions such as diabetes, or kidney failure, or those taking beta-blockers (e.g., metoprolol, atenolol), angiotensin converting enzyme inhibitors (ACE inhibitors; e.g., ramipril, enalapril), or some diuretics (water pills; e.g., hydrochlorothiazide).

Stomach problems: Stomach ulcers, perforation, and bleeding from the stomach have been known to occur during therapy with sulindac. These complications can occur at any time, and are sometimes severe enough to require immediate medical attention. The risk of ulcers and bleeding are increased for people taking higher doses of NSAIDs for longer periods of time.

Sulindac should be taken under close medical supervision by people prone to irritation of the stomach and intestines, particularly those who have had a stomach ulcer, bloody stools, or diverticulosis or other inflammatory disease of the stomach or intestines (such as ulcerative colitis or Crohn's disease). In these cases, your doctor must weigh the benefits of treatment against the possible risks.

Stop taking the medication and contact your doctor immediately if you experience symptoms or signs suggestive of stomach ulcers or bleeding in the stomach (black, tarry stools). These reactions can occur at any time during treatment without warning.

Surgery: If you are going to have any kind of surgery (including dental surgery), tell your doctor or dentist that you are taking this medication.

Pregnancy: This medication should not be used during the first 3 months of pregnancy unless the benefits outweigh the risks. When it is taken during the 20th to 28th week of pregnancy, there is the risk that the baby's kidneys will not develop properly and complications may occur with the pregnancy. Do not use sulindac or any other non-steroidal anti-inflammatory medication during the third trimester (last 3 months) of pregnancy. This may cause longer childbirth or high blood pressure in the baby's lungs. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if sulindac passes into breast milk. If you are breast-feeding and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children under the age of 12.

Seniors: Seniors, as well as those who are frail or debilitated, appear to have a higher risk of side effects with this medication. The lowest effective dose should be used, and seniors should be closely followed by their doctors while taking this medication.

There may be an interaction between sulindac and any of the following:

• alcohol
• aliskiren
• aminoglycoside antibiotics (e.g., amikacin, gentamycin, tobramycin)
• anagrelide
• angiotensin II receptor blockers (ARBs; e.g., candesartan, irbesartan)
• angiotensin converting enzyme (ACE) inhibitors (e.g., ramipril)
• beta-blockers (e.g., metoprolol, atenolol)
• bimatoprost
• bismuth subsalicylate
• bisphosphonates (e.g., etidronate, pamidronate, risedronate, zoledronic acid)
• cholestyramine
• clopidogrel
• colesevelam
• colestipol
• corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
• cyclosporine
• dasatinib
• deferasirox
• desmopressin
• dipyridamole
• diuretics (water pills; e.g., furosemide, hydrochlorothiazide, spironolactone)
• digoxin
• drospirenone
• eplerenone
• fluoroquinolone antibiotics (e.g., ciprofloxacin, levofloxacin, ofloxacin)
• ginger
• latanoprost
• medications that affect blood clotting (e.g., acetylsalicylic acid [ASA], apixaban, clopidogrel, enoxaparin, dalteparin, heparin, rivaroxaban, tinzaparin, warfarin)
• methotrexate
• metformin
• multivitamin and mineral supplements
• obinutuzumab
• olsalazine
• omega-3 fatty acids
• other NSAIDs (e.g., celecoxib, naproxen, indomethacin)
• pentoxifylline
• potassium supplements
• prasugrel
• probenecid
• selective serotonin reuptake inhibitors (SSRIs; e.g., paroxetine, fluoxetine, citalopram, sertraline)
• serotonin-norepinephrine reuptake inhibitors (SNRIs; desvenlafaxine, duloxetine, venlafaxine)
• sodium phosphates
• sulfasalazine
• tacrolimus
• tenofovir
• ticagrelor
• tipranavir
• tricyclic antidepressants (e.g., amitriptyline, doxepin, imipramine)
• vaccines
• vancomycin
• vitamin E
• voriconazole

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.