Sulindac adverse effects

In 40 patients with rheumatoid arthritis enrolled in a double-blind trial of fentiazac 400 mg/day or sulindac 200 mg/day for 3 months, adverse effects were reported in three patients taking fentiazac (rash, headache, epigastric pain) (2). 

Widespread use of naproxen, sulindac, diclofenac, and diflunisal probably explains why they were the most frequently rmphcated, rather than because they have a greater tendency to cause these adverse effects. NSAIDs differ in their ability to cause adverse skin reactions in terms of both frequency and severity pyrazolones, butazones, and oxicams are most often blamed, and among the arylalkanoic acid derivatives fenbufen and carprofen are most often incriminated. 

The types of skin adverse effect also vary with different compounds. The most serious life-threatening reactions, such as erythema multiforme and its variants (Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative erythroderma) are uncommon and occur mainly with the butazone derivatives and to a lesser extent with piroxicam, sulindac, and possibly fenbufen. In large series reported in France, Germany, and the USA, NSAIDs are most often implicated 12 (44%) of the most commonly implicated 29 drugs (168). 

Pirazolac, a pyrazoloacetic acid derivative, caused heartburn, upper abdominal pain, cutaneous adverse effects (rashes, exacerbation of pre-existing eczema), and eosi-nophilia in early clinical studies (1). In two comparative studies it was withdrawn in 15-20% of patients, that is more often than the comparator NSAIDs (indometacin, sulindac) (SEDA-16, 111). 

Sulindac can cause all of the gastrointestinal adverse effects that are associated with indometacin, from... 

Several types of proven or suspected hypersensitivity have already been mentioned, for example in connection with the liver, but the exact mechanism of a particular adverse effect has not always been clear. One case of fever, pharyngitis, cervical lymphadenopathy, leukopenia, liver abnormalities, proteinuria, pulmonary infiltrates, and abdominal pain has been described. Another patient who previously took sulindac without problems developed pruritus, dyspnea, perioral edema, and lethargy after taking a single dose of sulindac 150 mg. 

Careful monitoring of patients with a history of ulcers is recommended. Gastric bleeding, nau.sca. diarrhea, dizziness and other adverse effects have been noted, but with a lower frequency than with aspirin. Sulindac i.s recommended for RA. OA. and ankyUssing spondylitis in a ISO- to 200-mg dose, twice daily. - It is available as labIcLs (ISO-jmI 200 mg). 

Takeuchi K, Abe K, Yasujima M, Sato M, Tanno M, Sato K, YoidtinagaK. No adverse effect of non-steroidal anti-inflammatory drugs, sulindac and diclofenac sodium, on blood pressure control with a calcium antagonist, nifedipine, in elderly hypertensive patients. TchokuJExp Med (1991) 165, 201-Z... 

The arylpropionic acid derivatives are useful for the treatment of rheumatoid arthritis and osteoarthritis, for reduction of mild to moderate pain and fever, and for pain associated with dysmenorrhea. Side effects of the drugs are similar to but less severe than those described for the salicylates. Those who are sensitive to salicylates also may be sensitive to and have adverse reactions when taking ibuprofen and related drugs. Acute hypersensitivity to ibuprofen has been reported in patients with lupus. The hypersensitivity reaction to sulindac can be fatal. The use of sulindac has also been linked to cases of acute pancreatitis. The use of dimethylsulfoxide (DMSO) topically in combination with sulindac has been reported to induce severe neuropathies. The concurrent use of ibuprofen with aspirin reduces the antiinflammatory effects of both drugs. Ibuprofen is contraindicated in patients with aspirin sensitivity leading to bronchiolar constriction and in patients with an-gioedema. As with all NSAIDs, renal and liver function should be normal for adequate clearance of the drugs. 

The indications and adverse reactions of sulindac are similar to those of other NSAIDs. In addition to its rheumatic disease indications, sulindac suppresses familial intestinal polyposis it may inhibit the development of colon, breast, and prostate cancer in humans. It appears to inhibit the occurrence of gastrointestinal cancer in rats. The latter effect may be caused by the sulfone rather than the sulfide. 

Whereas the toxicity of sulindac is lower than that observed for indomethacin and other NSAIDs, the spectrum of adverse reactions is very similar. The most frequent side effects reported are associated with irritation of the Gl tract (e.g., nausea, dyspepsia, and diarrhea), although these effects generally are mild. Effects on the CNS (e.g., dizziness and headache) are less common. Dermatological effects are less frequently encountered. 

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