Sulindac (patient information)

# IMPORTANT WARNING:
People who take nonsteroidal anti-inflammatory medications (NSAIDs) (other than aspirin) such as sulindac may have a higher risk of having a heart attack or a stroke than people who do not take these medications. These events may happen without warning and may cause death. This risk may be higher for people who take NSAIDs for a long time. Tell your doctor if you or anyone in your family has or has ever had heart disease, a heart attack, or a stroke, if you smoke, and if you have or have ever had high cholesterol, high blood pressure, or diabetes. Get emergency medical help right away if you experience any of the following symptoms: chest pain, shortness of breath, weakness in one part or side of the body, or slurred speech.
If you will be undergoing a coronary artery bypass graft (CABG; a type of heart surgery), you should not take sulindac right before or right after the surgery.
NSAIDs such as sulindac may cause ulcers, bleeding, or holes in the stomach or intestine. These problems may develop at any time during treatment, may happen without warning symptoms, and may cause death. The risk may be higher for people who take NSAIDs for a long time, are older in age, have poor health, or drink large amounts of alcohol while you are taking sulindac. Tell your doctor if you take any of the following medications: anticoagulants ('blood thinners') such as warfarin (Coumadin); aspirin; other NSAIDs such as diflunisal (Dolobid), ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn), or oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone). Also tell your doctor if you have or have ever had ulcers or bleeding in your stomach or intestines, or other bleeding disorders. If you experience any of the following symptoms, stop taking sulindac and call your doctor: stomach pain, heartburn, vomiting a substance that is bloody or looks like coffee grounds, blood in the stool, or black and tarry stools.
Keep all appointments with your doctor and the laboratory. Your doctor will monitor your symptoms carefully and will probably order certain tests to check your body's response to sulindac. Be sure to tell your doctor how you are feeling so that your doctor can prescribe the right amount of medication to treat your condition with the lowest risk of serious side effects.
Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with sulindac and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website () or the manufacturer's website to obtain the Medication Guide.

# Why is this medication prescribed
Sulindac is used to relieve pain, tenderness, swelling, and stiffness caused by osteoarthritis (arthritis caused by a breakdown of the lining of the joints), rheumatoid arthritis (arthritis caused by swelling of the lining of the joints), and ankylosing spondylitis (arthritis that mainly affects the spine). Sulindac also is used to treat pain in the shoulder caused by bursitis (inflammation of a fluid-filled sac in the shoulder joint) and tendinitis (inflammation of the tissue that connects muscle to bone). It is also used to relieve gouty arthritis (attacks of severe joint pain and swelling caused by a build-up of certain substances in the joints). Sulindac is in a class of medications called NSAIDs. It works by stopping the body's production of a substance that causes pain, fever, and inflammation.

# How should this medicine be used
Sulindac comes as a tablet to take by mouth. It is usually taken with food twice a day. Take sulindac at around the same times each day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take sulindac exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Sulindac helps control arthritis pain but does not cure arthritis. If you are taking sulindac to treat arthritis pain, it may take 1 week or longer before you feel the full benefit of sulindac.

# Other uses for this medicine
Sulindac is also sometimes used to reduce the number of polyps (abnormal growths) in the colon (large intestine) and rectum in patients with familial adenomatous polyposis (a condition in which hundreds or thousands of polyps form in the colon and cancer may develop). Talk to your doctor about the risks of using this medication for your condition.
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

# What special precautions should I follow
Before taking sulindac:
- tell your doctor and pharmacist if you are allergic to sulindac, aspirin or or other NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), or any other medications.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following: angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik);angiotensin II receptor antagonists such as candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), valsartan (Diovan); cyclosporine (Neoral, Sandimmune); diuretics ('water pills'); lithium (Eskalith, Lithobid); oral medications for diabetes; methotrexate (Rheumatrex); and probenecid (Benemid).
- tell your doctor if you have or have ever had any of the conditions mentioned in the IMPORTANT WARNING section or asthma, especially if you also have frequent stuffed or runny nose or nasal polyps (swelling of the lining of the nose); kidney stones; swelling of the hands, arms, feet, ankles, or lower legs;or liver or kidney disease.
- tell your doctor if you are pregnant, especially if you are in the last few months of your pregnancy, you plan to become pregnant, or you are breast-feeding. If you become pregnant while taking sulindac, call your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking sulindac.

# What special dietary instructions should I follow
Unless your doctor tells you otherwise, continue your normal diet.

# What should I do if I forget a dose
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

# Side effects

## Mild side effects
Sulindac may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- headache
- dizziness
- nervousness
- diarrhea
- constipation
- gas
- ringing in the ears

## Severe side effects
Some side effects can be serious. If you experience any of the following symptoms, or those mentioned in the IMPORTANT WARNING section, call your doctor immediately. Do not take any more sulindac until you speak to your doctor:
- unexplained weight gain
- fever
- chills
- cough
- sweating
- flushing
- muscle or joint pain
- chest pain
- blisters
- rash
- itching
- hives
- swelling of the eyes, face, lips, tongue, throat, arms, hands, feet, ankles, or lower legs
- difficulty breathing or swallowing
- hoarseness
- pale skin
- fast hearbeat
- excessive tiredness
- unusual bleeding or bruising
- lack of energy
- upset stomach
- loss of appetite
- pain in the upper right part of the stomach
- flu-like symptoms
- yellowing of the skin or eyes
- cloudy, discolored, or bloody urine
- back pain
- difficult or painful urination
- blurred vision or other problems with sight
Sulindac may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# What storage conditions are needed for this medicine
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
- loss of consciousness
- fainting
- dizziness
- blurred vision
- upset stomach
- decreased urination

# What other information should I know
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Clinoril