• Management of inflammatory disorders, including:
  • Rheumatoid arthritis,
  • Osteoarthritis,
  • Acute gouty arthritis,
  • Bursitis.

Contraindicated in:

• Hypersensitivity
• Cross-sensitivity may occur with other NSAIDs, including aspirin
• Active GI bleeding or ulcer disease
• Peri-operative pain from coronary artery bypass graft (CABG) surgery
• OB: May cause premature closure of ductus arteriosus in third trimester.

Use Cautiously in:

• Cardiovascular disease or risk factors for cardiovascular disease (may ↑ risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, especially with prolonged use or use of higher doses)
• Severe renal or hepatic disease (dosage modification recommended)
• History of ulcer disease
• OB: Use in first and second trimester only if maternal benefit exceeds potential risks to fetus
• Lactation: Pedi: Safety not established
• Geri: May ↑risk of GI bleeding.

CNS: dizziness, headache, drowsiness.

EENT: blurred vision, tinnitus.

CV: HF, MYOCARDIAL INFARCTION, STROKE, edema, hypertension.

GI: GI BLEEDING, DRUG-INDUCED HEPATITIS, constipation, diarrhea, discomfort, dyspepsia, nausea, vomiting, anorexia, flatulence, pancreatitis.

GU: renal failure.

Derm: EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, rash, photosensitivity.

Hemat: blood dyscrasias, prolonged bleeding time.
Misc: AND ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS HYPERSENSITIVITY SYNDROME.

Drug-Drug:

• Concurrent use of aspirin may ↓ effectiveness.
• ↑risk of bleeding with anticoagulants, thrombolytic agents, tirofiban, eptifibatide, clopidogrel, cefotetan, or valproic acid.
• ↑adverse GI side effects with aspirin, corticosteroids, and other NSAIDs.
• May ↓ response to antihypertensives or diuretics.
• May ↑ levels and risk of toxicity from lithium.
• May ↑ risk of hematologic toxicity from antineoplastics or radiation therapy.
• May ↑ risk of adverse renal effects with cyclosporine or chronic use of acetaminophen.
• May blunt the antihypertensive effect of and ↑ the risk of renal dysfunction associated with ACE inhibitors or angiotensin II antagonists.
• Antacids↓ levels and decrease effectiveness of sulindac.
• ↑risk of photosensitivity reactions with other photosensitizing medications.
• ↑risk of hypoglycemia with insulins or oral hypoglycemic agents.
• Should not be used concurrently with dimethyl sulfoxide because of ↑ risk of peripheral neuropathy and ↓ levels of sulindac and its metabolite.

(Generic available)

• Tablets: 150 mg; 200 mg;

• PO (Adults): 150–200 mg twice daily (not to exceed 400 mg/day).

Clinoril

• Inhibits prostaglandin synthesis.

• Suppression of pain and inflammation.

Therapeutic Classification: antirheumatics, nonsteroidal anti-inflammatory agents

Absorption: Well absorbed from the GI tract after oral administration.

Distribution: Unknown. Enters breast milk in small amounts.

Metabolism/Excretion: Converted by the liver to active drug. Minimal amounts excreted unchanged by the kidneys.

Half-life: 7.8 hr (16.4 hr for active metabolite).

• Advise patient to take this medication with a full glass of water and to remain in an upright position for 15–30 min after administration.
• Instruct patient to take medication as directed. Take missed doses as soon as remembered but not if almost time for the next dose. Do not double doses.
• May cause dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known.
• Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications. Caution patient to avoid the concurrent use of alcohol, aspirin, NSAIDs, or acetaminophen.
• Advise patient to inform health care professional of medication regimen before treatment or surgery.
• Advise patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
• Advise patient to consult health care professional if itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headache, or influenza-like syndrome (chills, fever, muscle aches, pain) occurs.
• Instruct patient to notify health care professional immediately if rash, shortness of breath, trouble breathing, slurred speech, chest pain, swelling of face or throat, or weakness in 1 part or side of your body occur.
• Advise patient to inform health care professional if pregnancy is planned or suspected, or if breastfeeding.

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