What To Know About Clinoril (Sulindac)

An Anti-Inflammatory Drug Used For Pain Relief

Clinoril (sulindac) is medication prescribed to take on pain, swelling, tenderness, and other symptoms of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis (a chronic inflammation of the spine), as well as shoulder discomfort due to bursitis. In combination with chemotherapy drugs, it may also be used to take on familial adenomatous polyposis.

This drug comes in tablet form and is taken orally. Sulindac is the generic form. Part of a class of drugs called non-steroidal anti-inflammatory drugs (NSAIDs), which includes aspirin and ibuprofen, among others, this medication works by suppressing the activity of hormones associated with pain sensation, inflammation, and fever.

Though highly successful in managing symptoms, taking Clinoril may not be safe for some people, and there’s always a risk of adverse effects. Getting the most out of this medication means understanding what it does, how to take it, and what to look out for when doing so.

Instructions on a pill bottle - stock photo

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Uses

As a medication that primarily takes on pain and inflammation, Clinoril won’t cure an underlying condition; rather, this drug helps with comfort and function. Specifically, it’s approved by the U.S. Food and Drug Administration (FDA) to treat both chronic and acute symptoms of:

  • Osteoarthritis: The most common form of arthritis, osteoarthritis is when cartilage in the joints becomes worn out due to use and aging. Among other NSAIDs, Clinoril reduces the pain, swelling, and stiffness associated with this condition.  
  • Rheumatoid arthritis: This form of arthritis occurs when the immune system starts attacking and breaking down cartilage in the joints. It can also impact other parts of the body, including the skin, heart, lungs, heart, and nerves.
  • Ankylosing spondylitis: A painful, chronic inflammation of the spine, ankylosing spondylitis is a form of arthritis that leads to pain and stiffness in the lower back. Clinoril is effective in managing associated discomfort as a longer-term therapy.    
  • Shoulder bursitis: Characterized by pain, swelling, and loss of mobility in the shoulder, this condition is also known as “rotator cuff tendonitis.” It occurs when bursa (fluid-filled sacs that help cushion joints) and tendons become inflamed.    
  • Acute gouty arthritis: Clinoril is also known to be effective in taking on acute attacks of gout, in which mineral deposits form in the joints. Most often seen in the big toe, this condition is very painful.

Off-Label Uses

More recently, combined therapy of chemotherapy drug, Tarceva (erlotinib) and Clinoril has been found to prevent the development of colorectal polyps—growths in the colon and small intestines—due to familial adenomatous polyposis.

In cases of this rare, inherited disease, these polyps are highly likely to become cancerous, leading to colon cancer, as well as that of the duodenum (a part of the small intestine).

In one study, those that underwent the combined Tarceva and Clinoril regimen had on average 70% fewer colorectal polyps than they did before treatment at six months afterward. Clearly, it’s a promising addition to the doctor’s toolkit when it comes to taking on colon cancer.

Before Taking

As an analgesic (pain-relieving) and anti-inflammatory drug, Clinoril is indicated both for short-term and chronic pain. A generic form, called sulindac, is also available.

Since it’s most often used to manage symptoms of different forms of arthritis, rather than actually curing these conditions, this drug may be indicated at any point of therapy. That said, in the treatment of osteoarthritis, rheumatoid arthritis, and other arthritis conditions, Clinoril or a comparable NSAID will typically be tried before surgery.

Before it’s prescribed, doctors make sure the source of the discomfort is indeed related to arthritis, and carefully screen patients. In addition, doctors may test liver and kidney function as this drug can impact these functions, while evaluating medical history.

The FDA recommends that doctors be as minimal possible when prescribing this and all pain-relieving medications. The aim, then, is to find the smallest possible effective dose, while monitoring carefully to minimize the possibility of adverse side-effects.

Know What You're Taking

If you’ve been prescribed Clinoril, talk to your doctor about all the medications, supplements, and vitamins you’re currently taking. While some drugs pose only minor interaction risks at most, others may outright contraindicate use or prompt careful consideration as to whether the benefits outweigh the risks of treatment.

 Precautions and Contraindications

Though generally well-tolerated, a number of conditions and factors are contraindicators, while others significantly elevate the risk of adverse side-effects. Patients for whom Clinoril is contraindicated include:

  • Are allergic to Clinoril
  • Develop asthma, hives, or welts, after taking aspirin or other NSAIDs
  • Have had coronary artery bypass (CABG) surgery within 14 days

In addition, history of or presence of several other factors make prescription of this drug risky, often ruling it out:

  • Coronary thrombosis (blood clots in the heart)
  • Recent myocardial infarction (heart attack)
  • Hypertension (high blood pressure)
  • Heart failure and edema (swelling)
  • High cholesterol
  • Presence or history of ulcer disease or gastrointestinal bleeding
  • Liver dysfunction
  • Renal insufficiency (chronic kidney disease)
  • Late pregnancy

Not only that, extra precautions and monitoring are needed for:

  • Anemia or blood clotting disorders
  • Asthma
  • History or presence of kidney stones
  • Pancreatitis (infection of the pancreas)
  • History of liver problems
  • Systemic lupus erythematosus (SLE)
  • Patients over 65
  • Class IV rheumatoid arthritis (the patient is incapacitated, bedridden, and unable to walk)
  • Pediatric patients
  • Nursing parents

Other NSAIDs

Clinoril is part of a broad class of NSAIDs, many of which are available in both over-the-counter and prescribed forms. The most common of these are:

Dosage

There are two strengths that Clinoril comes in: 150 milligrams (mg) or 200 mg tablets. The amount you’re prescribed will vary based on the condition and your individual case. It’s recommended, however, that patients never take more than 400 mg in a day.

Here’s a quick breakdown of recommended dosages based on condition:

  • A baseline of 300 mg a day, in two doses of 150 mg, is recommended for initial treatment of osteoarthritis, rheumatoid arthritis, and ankylosing spondylosis. Depending on how well it’s working, this dosage may be reduced or raised as needed. While the effect is often seen within a week, more time may be needed.
  • 400 mg a day in divided doses of 200 mg, is employed to take on shoulder bursitis and gouty arthritis cases. This is adjusted based on the progression of symptoms; the duration of prescription for the former of these 7 to 14 days, while symptoms of the latter should resolve within a week.

 

Doublecheck Your Dosages

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your doctor to make sure you are taking the right dose for you.

Modifications

As noted, dosages can vary a great deal and are often adjusted, and Clinoril shouldn’t be taken if symptoms subside. To prevent adverse reactions dosages are reduced for those:

  • Over 65 (especially if indicated for chronic pain)
  • With liver problems
  • Who have renal insufficiency

How to Take and Store

As your doctor or pharmacist will tell you, there are also a number of things to keep in mind when it comes to taking and storing Clinoril:

  • Store at room-temperature, inside the sealed pill bottle, away from the reach of children.
  • Take it with food to help minimize side-effects; most take one at breakfast and one at dinner.
  • If you miss a dose, take one as soon as you remember and get back to your normal schedule as you can; don’t double up.
  • Don’t crush or split the tablets; take them whole.
  • Overdose is a medical emergency characterized by loss of consciousness, seizure, breathing difficulty, dizziness, nausea, and difficulty urinating; call 911 in these cases.
  • Dispose of unused tablets by taking them to a pharmacy or safe disposal site.

Side-Effects

Common

As with all NSAIDs, and especially when taken for chronic cases or by those over 65, Clinoril can cause side-effects, ranging from the milder to the severe and life-threatening. Among the more common of these are:

  • Headache
  • Dizziness
  • Nervousness
  • Nausea with or without vomiting
  • Diarrhea
  • Constipation
  • Skin rash and/or itching
  • Gas
  • Tinnitus (ringing in the ears)

If these symptoms become persistent or severe, be sure to let your doctor know as soon as possible.

Severe

The more severe and life-threatening side-effects of Clinoril are related to this drug’s impact on kidney, liver, blood, and heart function, though other organs and systems can be affected. If you experience any of these, stop taking the medication and seek emergency medical help:

  • Signs of heart failure, such as sudden weight gain, swelling in the hands and feet, severe fatigue, and sudden weight gain
  • Liver disease, which is characterized by jaundice (a yellowing of the skin and/or eyes), dark urine, nausea, vomiting, and severe abdominal pain
  • Kidney problems that lead to difficulty urinating, blood in the urine, and neck stiffness
  • Severe allergic shock, causing swelling in the face, hands, feet, and throat, as well as shortness of breath, dizziness, and severe skin rash
  • Gastrointestinal bleeding, such as ulcers, or bleeding in the intestines or anus
  • Cognitive effects, such as confusion and rapid, unexplained mood changes

Warnings and Interactions

Alongside being mindful of side-effects of Clinoril as well as the right way to use it, it’s important to be aware of lifestyle changes that will be needed during treatment:

  • Alcohol, when taken with any NSAID drug, can be very dangerous due to an increased risk of stomach ulcer or other gastrointestinal issues. Drinking should be minimized or cut out while on Clinoril.
  • Cannabis (marijuana) users may also want to avoid mixing substances, due to the risk of dizziness and disorientation.
  • Sun exposure should be limited due to increased skin sensitivity; wear sunscreen and avoid tanning beds.

It’s also important to be aware of the way this medication can interact with other drugs, whether they’re prescribed, or over-the-counter. Taking the following along with Clinoril increases the chance of side-effects, adverse reactions, or reduce efficacy:

  • Other NSAIDs or oral steroids, such as aspirin, Celebrex, Advil, dexamethasone, Medrol (methylprednisolone), and prednisone
  • Angiotensin-converting enzyme (ACE) inhibitors such as Lotensin (benazepril), Vasotec (enalapril), Zestoretic (lisinopril), and others
  • Angiotensin II receptor antagonists such as Atacand (candesartan), Teveten (eprosartan), Avapro (irbestan), etc.
  • Anticoagulant drugs, or “blood thinners,” include Coumadin (warfarin)
  • Selective-serotonin reuptake inhibitors (SSRIs) including Celexa (citalopram) and Prozac (fluoxetine)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Khedezia or Pristique (desvenlafaxine), Effexor XR (venlafaxine), and Cymbalta (duloxetine)
  • Other medications including oral diabetes medications, diuretics (or “water pills”), lithium, methotrexate, and Probalan (probenecid)

Lastly, some herbs and supplements have been known to interact poorly with NSAIDs like Clinoril:

  • St. John’s wort
  • Vitamin E
  • Garlic
  • Citrate supplements
  • Feverfew

This isn’t a list of all possible drugs, herbs, and supplements that can interact with Clinoril. Check the pharmaceutical labeling and talk to your pharmacist or doctor to learn more about what’s safe to take. 

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Article Sources
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