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Sulindac

Also indexed as: Clinoril®

Sulindac is used to treat rheumatoid arthritis, osteoarthritis and ankylosing spondylitis, a rheumatic disorder involving the spine and large joints. It also treats both acute painful shoulder and gouty arthritis. Sulindac is in a class of medications known as non-steroidal anti-inflammatory drugs (NSAIDs).

Interactions with Dietary Supplements

Potassium
Four people who took sulindac developed high blood levels of potassium, which returned to normal within a few days after the drug was stopped.1 Controlled research is needed to determine whether potassium supplements or a high potassium diet might aggravate this problem. Until more information is available, people taking sulindac and potassium supplements, potassium containing salt substitutes, or large amounts of fruits and vegetables should have potassium blood levels checked regularly by their doctor.

Folic acid
Sulindac blocks the activity of enzymes that depend on folic acid2 and may, like aspirin, reduce the amount of folic acid in red blood cells.3 Further research is needed to determine whether supplementing folic acid changes the effects of sulindac therapy or prevents a deficiency of this vitamin in the body.

Lithium
Lithium is a mineral that may be present in some supplements and is also used in large amounts to treat mood disorders such as manic-depression (bipolar disorder). Most NSAIDs inhibit the excretion of lithium from the body, resulting in higher blood levels of the mineral, though sulindac may have an opposite effect.4 Since major changes in lithium blood levels can produce unwanted side effects or interfere with its efficacy, NSAIDs should be used with caution, and only under medical supervision, in people taking lithium supplements.

Interactions with Herbs

White willow bark (Salix alba)
White willow bark contains salicin, which is related to aspirin. Both salicin and aspirin produce anti-inflammatory effects after they have been converted to salicylic acid in the body. The administration of salicylates like aspirin to individuals taking oral NSAIDs may result in reduced blood levels of NSAIDs.5 Though no studies have investigated interactions between white willow bark and NSAIDs, people taking NSAIDs should avoid the herb until more information is available.

Interactions with Foods and Other Compounds

Green tea
Current research is exploring the possibility sulindac and other NSAIDs might inhibit cancer growth.6 7 Test tube studies have shown catechins, which are compounds found in green tea, significantly enhance the ability of sulindac to cause the death of and inhibit the growth of lung cancer cells.8 Controlled research is needed to determine whether green tea and sulindac might inhibit the growth of certain cancers in humans.

Alcohol
Drinking large quantities of alcoholic beverages over a long period may block the breakdown of sulindac, resulting in higher than normal blood levels of the drug.9 Consequently, side effects and tissue damage caused by sulindac might occur unless an adjustment is made in the amount of drug taken each day.

Summary of Interactions for Sulindac

Depletion or interference Potassium*
Adverse interaction Alcohol
Lithium*
White willow*
Side effect reduction/prevention None known
Supportive interaction None known
Reduced drug absorption/bioavailability None known
Other (see text) Folic acid*

For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

References:

1. Nesher G, Zimran A, Hershko C. Hyperkalemia associated with sulindac therapy. J Rheumatol 1986;13:1084–5.

2. Baggott JE, Morgan SL, Ha T et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J 1992;282:197–202.

3. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid, and aspirin. Blood 1971;38:405–16.

4. Olin BR, ed. Central Nervous System Drugs, Analgesics and Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172–90.

5. Olin BR, ed. Central Nervous System Drugs, Analgesics and Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172–90.

6. Lim JT, Piazza GA, Han EK et al. Sulindac derivatives inhibit growth and induce apoptosis in human prostate cancer cell lines. Biochem Pharmacol 1999;58:1097–107.

7. Ahnen DJ. Colon cancer prevention by NSAIDs: what is the mechanism of action? Eur J Surg Suppl 1998;582:111–4.

8. Suganuma M, Okabe S, Sueoka N et al. Green tea and cancer chemoprevention. Mutat Res 1999;428:339–44.

9. Gallanosa AG, Spyker DA. Sulindac hepatotoxicity: a case report and review. J Toxicol Clin Toxicol 1985;23:205–38.