Sulindac pharmacokinetics

Malloy MJ, Ravis W Pennell AT, Hagan DR, Betagari S, Doshi DH. Influence of cholestyramine resin administration on single dose sulindac pharmacokinetics. IntJ Clin Pharmacol Ther 994)32, 286-9. 

Paracetamol levels are increased by diflunisal. Aspirin, diclofenac, nabumetone and sulindac pharmacokinetics do not appear to be affected by paracetamol. There is no pharmacokinetic interaction between ibuprofen and paracetamol. Propacetamol, and possibly paracetamol, increase the antiplatelet effects of diclofenac, although the evidence is limited and the clinical relevance of this is uncertain. 

Mattila J, Mantyla R, Vuorela A, et al. Pharmacokinetics of graded oral doses of sulindac in man. Arzneimittelforschung 1984 34(2) 226-229. 

This chapter concentrates on some drug choices in acute rather than chronic pain, but the same principles can be used to determine the appropriateness of other types of analgesic. The drugs considered in this section are paracetamol, non-steroidal anti-inflammatories (NSAIDs specifically diclofenac, ibuprofen, indometacin, naproxen, sulindac and tenoxicam) and opioids (codeine, dihydrocodeine, morphine, pethidine and tramadol). Unless otherwise stated, all pharmacokinetic data originate from standard reference sources [1-5] and apply to adults only. 

In a single-dose study examining the pharmacokinetics of sulindac and ibuprofen in 15 patients with alcoholic liver disease, no statistically significant effects were noted for ibuprofen elimination, half-life or AUC compared to the controls. However, there appeared to be delayed absorption in some patients [25]. 

An additional important finding from this study was the hme of onset of acute renal decompensation. Ibuprofen-induced renal failure occurred rapidly (within 8 days), but piroxicam and sulindac were not associated with any deterioration of renal function during the 11-day treatment period [39]. A pharmacokinetic analysis of the drugs used in these patients suggested the following Ibuprofen, which has a short elimination half-life, reached maximum serum concen-... 

Delhotal-Landes B, Flouvat B, Liote F, Abel L, Meyer P, Vinceneux P, Carbon C. Pharmacokinetic interactions between NSAIDs (indomethacin or sulindac) and H2-receptor antagonists (cimetidine or ranitidine) inhuman volunteers, Clin Pharmacol TTier (1988) 44,442-52. 

Not understood. In one patient, renal impairment may have caused sulindac accumulation, which in turn may have affected warfarin pharmacokinetics. See also Coumarins and related drugs + NSAIDs , p.427. 

Sulindac (mean dose 400 mg daily) had no effect on the pharmacokinetics of a single 10-mg/m intravenous dose of methotrexate, but it slightly increased the AUC of the 7-hydroxymethotrexate metabolite. ... 

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