Sulindac dosage

SULINDAC Administer twice/day with food. The usual maximum dosage is 400 mg/day. Dosages above 400 mg/day are not recommended. 

Eideriy Age appears to increase the possibility of adverse reactions to NSAIDs. The risk of serious ulcer disease is increased this risk appears to increase with dose. Ketorolac is cleared more slowly by the elderly use caution and reduce dosage. Pregnancy Category B (ketoprofen, naproxen, naproxen sodium, flurbiprofen, diclofenac, fenoprofen, ibuprofen, indomethacin, meclofenamate, sulindac). 

The interaction of NSAIDs with lithium has been reviewed briefly (663). Most NSAIDs, although perhaps not all (for example aspirin, sulindac), if given in sufficient dosages for sufficient time, can increase the serum lithium concentration, sometimes to the point of toxicity (664,665). 

Lithium Probably all NSAIDs ( except sulindac, aspirin) Inhibition of renal excretion of lithium, increasing lithium serum concentrations and increasing risk of toxicity Use sulindac or aspirin if an NSAID is unavoidable careful monitoring of serum lithium concentration and appropriate dosage reduction... 

Sulindac may be less hkely to cause renal toxicity than other NSAIDs (32), at least when it is used in low dosages, but there is some disagreement on this point (33-35), and five cases of nephrotic syndrome and renal insufficiency have been described (36,37). 

Nevertheless, sulindac is the preferred compound for clinical applications an oral dosage of this inactive bioprecursor will circumvent initial exposure of gastric and intestinal mucosa to the active drug and might thus provide a therapeutic advantage in comparison with the sulfide dosing. 

Sulindac is Indicated for long-term use in the treatment of rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and acute gouty arthritis. The usual maximum dosage is 400 mg/day, with starting doses recommended at 150 mg twice a day. It is recommended that sulindac be administered with food. 

Lithium levels increased. Two patients developed increased serum-lithium levels apparently due to the use of sulindac. In one case the lithium levels rose from 1 to 2 mmol/L after 19 days of treatment with sulindac 150 mg twice daily, and symptoms of toxicity were seen. The levels fell to 0.8 mmol/L within 5 days of stopping the sulindac. The other patient had a rise from 0.9 to 1.7 mmol/L within a week of adding sulindac 150 mg twice daily. The sulindac was continued and the lithium dosage was reduced from 1.8 to 1.5 g daily. The serum-lithium levels fell and were 1.2 mmol/L at 37 days and 1 mmol/L at 70 days. No symptoms of lithium toxicity occurred. ... 

The documentation of these interactions is variable and limited, and although only some NSAIDs have been shown to interact, it seems likely that they will all interact to a greater or lesser extent. What is known indicates that most NSAIDs should be avoided, especially if other risk factors are present, unless serum-lithium levels can be very well monitored (initially every few days) and the dosage reduced appropriately. The effeets of sulindac appear to be unpredictable (serum levels raised, lowered or unchanged) so that good monitoring is still necessary. 

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