Sulindac | Health Notes at WWSM | Health Information at WWSM

Sulindac

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Also indexed as: Apo-Sulin, Clinoril, Novo-Sulindac, Nu-Sulindac

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).

Summary of Interactions with Vitamins, Herbs, and Foods
In some cases, a herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.

May Be Beneficial: Depletion or interference—The medication may deplete or interfere with the absorption or function of the nutrient. Taking these nutrients may help replenish them.	Potassium*
Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.	Alcohol Lithium* White willow*
Check: Other—Before taking any of these supplements or eating any of these foods with your medication, read this article in full for details.	Folic acid*
Side effect reduction/prevention	None known
Supportive interaction	None known
Reduced drug absorption/bioavailability	None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

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 drinks 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.

References
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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires September 2008.

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Interactions with Dietary Supplements

Interactions with Herbs

Interactions with Foods and Other Compounds