Sulindac

How it works

It is a prodrug converted to an active sulphide metabolite that inhibits cyclo-oxygenase enzymes, reducing prostaglandin synthesis and thereby pain and inflammation.

Prescribing in practice

• Like other NSAIDs it carries gastrointestinal bleeding and ulceration risk; use the lowest effective dose for the shortest time and consider gastroprotection in those at risk.
• It can cause fluid retention and raise blood pressure, and may impair renal function, so caution applies in cardiovascular, renal or hepatic impairment and in the elderly.
• Avoid combining with other NSAIDs and use caution with anticoagulants and other drugs affecting bleeding or renal function.

Monitoring

Monitor blood pressure and renal function in those at risk with longer-term use, and review for gastrointestinal symptoms.

Counselling the patient

• Take with or after food and report indigestion, black stools or vomiting blood.
• Seek advice about other painkillers, as combining NSAIDs increases risk.
• Report swelling, breathlessness or reduced urine output.

Evidence & guidelines

NSAID class risks for gastrointestinal, cardiovascular and renal harm are well established and reflected in MHRA advice and NICE guidance.