Sulindac
NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs)Pregnancy: avoid
Avoid from week 20: from about 20 weeks NSAIDs can reduce amniotic fluid through their effect on the fetal kidney, and from about 30 weeks they can close the fetal ductus…
An NSAID whose activity lies in its sulfide metabolite. Used in arthritis, gout and painful shoulder; rare pancreatitis is typical.
Quick facts
- Group
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Target
- Cyclooxygenase 1 and 2 (COX-1/COX-2)
- Used for
- Osteoarthritis · Rheumatoid arthritis
- Key effects
- Abdominal pain · Diarrhoea or constipation · Dizziness
- Monitor
- Blood pressure · Signs of gastrointestinal bleeding
- ATC
- M01AB02
No doses: the clinician sets them by the current guideline.
Mechanism of action
Sulindac itself (a sulfoxide) is reduced in the body to its active sulfide, which inhibits prostaglandin synthesis by cyclooxygenase. The reduction is reversible; irreversible oxidation gives an inactive sulfone. The active sulfide lasts longer than the parent drug.
- Sulindac sulfoxide is reduced to the active sulfide
- The sulfide inhibits cyclooxygenase
- Fewer prostaglandins: less pain and inflammation
Indications
- Osteoarthritis Knee Osteoarthritis →
- Rheumatoid arthritis Rheumatoid arthritis →
- Ankylosing spondylitis Ankylosing spondylitis →
- Acute gouty arthritis Gout →
- Acute painful shoulder (subacromial bursitis, supraspinatus tendinitis)
Adverse effects
Common
- Abdominal pain, dyspepsia and nausea
- Diarrhoea or constipation
- Rash and itching
- Dizziness, headache and tinnitus
Contraindications
- Asthma, hives or allergic-type reactions after aspirin or another NSAID
- Pain around coronary artery bypass graft (CABG) surgery
- Previous serious skin reaction to an NSAID
Key interactions
- Dimethyl sulfoxide (DMSO)
- Less active sulfide and peripheral neuropathy; not combined
- Diflunisal and aspirin
- Lower levels of the active sulfide; not recommended
- Probenecid
- Higher sulindac levels and a slightly weaker uricosuric effect
- Lithium and methotrexate
- Higher levels and toxicity of lithium or methotrexate
What is monitored
- Blood pressure, swelling and signs of heart failure
- Signs of gastrointestinal bleeding (black stools, vomiting blood, anaemia)
- Kidney function, potassium, liver tests and blood count in long-term use
- Abdominal pain suggesting pancreatitis
Administration and safety
- Given by mouth at the lowest effective dose for the shortest time
- Good hydration in people with a history of kidney stones
Pregnancy and breastfeeding
Avoid from week 20: from about 20 weeks NSAIDs can reduce amniotic fluid through their effect on the fetal kidney, and from about 30 weeks they can close the fetal ductus arteriosus too early.
Nursing care
- Ask about ulcers, bleeding, kidney or heart disease and aspirin-sensitive asthma before the first dose
- Check blood pressure and fluid status during treatment
- Teach to report black stools, vomiting blood, chest pain, weakness on one side or rash
- Stop and report fever, rash or severe abdominal pain; the drug is not restarted after these reactions
Pharmacokinetics
- Metabolism
- Reversible reduction to the active sulfide; irreversible oxidation to the inactive sulfone
- Elimination
- About half in the urine, mostly as sulfone conjugates; about a quarter in the faeces
- Half-life
- About 8 hours for sulindac and about 16 hours for the active sulfide
Test yourself
Think of the answer, then tap the question to see it.
Which metabolite carries sulindac's activity?
The sulfide.
Which solvent must not be combined with sulindac?
Dimethyl sulfoxide (DMSO).
Which serious adverse effect is more typical of sulindac than of other NSAIDs?
Pancreatitis (also a hypersensitivity syndrome and kidney stones).
Connections
← Back to the class: Nonsteroidal anti-inflammatory drugs (NSAIDs)
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - SULINDAC tablet (DailyMed (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.