Can sulindac be given to a lithium treated patient without any risk for interaction?/nA 55-year old

Fråga: Can sulindac be given to a lithium treated patient without any risk for interaction?

A 55-year old man has been treated with Litarex 4 tablets/day for a long time. Now he has a tendinitis and needs treatment with an anti-inflammatory drug. Can sulindac be given in this case without risk for interaction?

Sammanfattning: Sulindac seems to be a rational NSAID-alternative in lithium treated patients since there is no convincing evidence that sulindac affects serum lithium levels to a clinically significant degree.

Svar: It is documented that several nonsteroidal anti-inflammatory drugs, eg indomethacin, ibuprofen and naproxen, can inhibit the renal clearance of lithium which leads to increased lithium levels. The inhibitory effect varies greatly among the different NSAIDs. Indometacin seems to be the most potent (1,2,3,5).

A literature search, including Drugline, Medline, and pharmacological handbooks has not revealed that sulindac increases serum lithium levels.

In six patients with steady state serum lithium concentrations who were treated with sulindac for six days, sulindac did not affect the serum lithium levels and lithium clearance (4).

In two lithium treated patients the sulindac administration resulted in a temporary decrease of lithium levels.

In the first case lithium levels stabilized within a month. In the second case the lithium dose was changed, resulting in a marked fluctuation of the serum lithium level. While elevation of serum lithium concentraton into the toxic range is directly hazardous to the patient a drop in serum level may not necessarily jeopardize the therapeutic control. The authors conclude that alterations in lithium dose should be avoided (5). 1 FASS 1996

2 Drugline nr 09495 (year 1992)
3 Hansten, Horn , Drug interactions & Updates. 1993; page 610
4 Ragheb M, Powell AL: Lithium interaction with sulindac and naproxen. J Clin Psychopharmacol 1986; 6: 150-154

5 Furnell MM, Davies J: The effect of sulindac on lithium therapy. Drug Intell Clin Pharm 1985 ; 19: 374-376