Drug interactions
Clopidogrel + Sulindac
Severity: Major
Clopidogrel and Sulindac: major interaction.
Last updated Sources: Health Canada product monograph
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Sulindac impairs platelet function and can irritate the gastrointestinal mucosa, while clopidogrel adds irreversible platelet inhibition. Together they raise the risk of gastrointestinal and other bleeding above that of either drug alone.
What this interaction means in plain words
Clopidogrel and Sulindac can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Clopidogrel belongs to Cardiovascular; Sulindac belongs to Musculoskeletal.
Why it happens
Additive pharmacodynamic effect on hemostasis: reversible COX-1 inhibition by the NSAID plus P2Y12 blockade by clopidogrel, with NSAID-related mucosal injury.
What to do
Avoid the combination where possible and choose a non-NSAID analgesic such as paracetamol. If it is unavoidable, use the shortest course and consider gastroprotection with a proton pump inhibitor while watching for bleeding.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Sulindac
- Ketorolac intranasal + Sulindac Contraindicated
- Ketorolac + Sulindac Contraindicated
- Aceclofenac + Sulindac Major
- Acetylsalicylic acid + Sulindac Major
- Alteplase + Sulindac Major
- Amiloride + Sulindac Major
Other interactions of Clopidogrel
Frequently asked questions
Can I take Clopidogrel with Sulindac?
MediHelp rates the interaction as major. Clopidogrel and Sulindac can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Sulindac impairs platelet function and can irritate the gastrointestinal mucosa, while clopidogrel adds irreversible platelet inhibition. Together they raise the risk of gastrointestinal and other bleeding above that of either drug alone.
How serious is the interaction between Clopidogrel and Sulindac?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible and choose a non-NSAID analgesic such as paracetamol. If it is unavoidable, use the shortest course and consider gastroprotection with a proton pump inhibitor while watching for bleeding.
What other medicines interact with Sulindac?
MediHelp also lists interactions of Sulindac with, for example, Ketorolac intranasal, Ketorolac, Aceclofenac. The full list is on the Sulindac page.
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