sulindac
CLINICAL USE
NSAID and analgesic
DOSE IN NORMAL RENAL FUNCTION
200 mg twice daily
PHARMACOKINETICS
Molecular weight :356.4 %Protein binding :95 %Excreted unchanged in urine : 7 Volume of distribution (L/kg) :No datahalf-life – normal/ESRD (hrs) :7.8/16.4 (metabolite)/Unchanged DOSE IN RENAL IMPAIRMENT
GFR (mL/MIN)
20 to 50 : Dose as in normal renal function. Avoid if possible 10 to 20 : Give 50–100% of normal dose. Avoid if possible <10 : Give 50–100% of normal dose. Avoid if possible DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD :Unlikely to be dialysed. Dose as in GFR <10 mL/min HD :Not dialysed. Dose as in GFR <10 mL/min HDF/high flux :Unknown dialysability. Dose as in GFR <10 mL/minCAV/VVHD :Unknown dialysability. Dose as in GFR 10 to 20 mL/min IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsACE inhibitors and angiotensin-II antagonists: antagonism of hypotensive effect; increased risk of nephrotoxicity and hyperkalaemiaAnalgesics: avoid concomitant use of 2 or more NSAIDs, including aspirin (increased side effects); avoid with ketorolac (increased risk of side effects and haemorrhage)Antibacterials: possibly increased risk of convulsions with quinolonesAnticoagulants: effects of coumarins enhanced; possibly increased risk of bleeding with heparins and coumarinsAntidepressants: increased risk of bleeding with SSRIs and venlafaxineAntidiabetic agents: effects of sulphonylureas enhancedAnti-epileptics: possibly increased phenytoin concentrationAntivirals: increased risk of haematological toxicity with zidovudine; concentration possibly increased by ritonavirCiclosporin: may potentiate nephrotoxicity Cytotoxic agents: reduced excretion of methotrexate; increased risk of bleeding with erlotinib Diuretics: increased risk of nephrotoxicity; antagonism of diuretic effect; hyperkalaemia with potassium-sparing diuretics Lithium: excretion decreased Pentoxifylline: increased risk of bleeding Tacrolimus: increased risk of nephrotoxicity ADMINISTRATION
Reconstition
– Route
Oral Rate of Administration
–Comments
– OTHER INFORMATION
Sulindac has become the NSAID of choice in some centres for patients with renal impairment because of reports of its renal sparing effects. There is evidence that this sparing effect is dose-related and is lost if doses above 100 mg twice daily are usedInhibition of renal prostaglandin synthesis by NSAIDs may interfere with renal function, especially in the presence of existing renal disease – avoid NSAIDs if possible; if not, check serum creatinine 48–72 hours after starting NSAID – if increased, discontinue therapyUse normal doses in patients with CKD 5 on dialysis if they do not pass any urineUse with caution in renal transplant recipients (can reduce intrarenal autocoid synthesis).
See how to identify renal failure stages according to GFR calculation
See how to diagnose irreversible renal disease
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