Drug interactions
Lithium + Sulindac
Severity: Major
Lithium and Sulindac: major interaction.
Last updated
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
NSAIDs can raise serum lithium concentrations and precipitate lithium toxicity. Sulindac is considered to have less effect than other NSAIDs, but cases of raised lithium levels have been reported.
What this interaction means in plain words
Lithium 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.
Lithium belongs to Central Nervous System; Sulindac belongs to Musculoskeletal.
Why it happens
NSAIDs reduce renal prostaglandin synthesis and renal blood flow, decreasing lithium renal clearance.
What to do
Check lithium levels within about a week of starting or changing the NSAID and reduce lithium dose as required. Monitor for tremor, nausea, confusion and ataxia, or choose an alternative analgesic.
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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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 Lithium
- Lithium + Thioridazine Contraindicated
- Lithium + Vandetanib Contraindicated
- Aceclofenac + Lithium Major
- Acemetacin + Lithium Major
- Amisulpride + Lithium Major
- Amlodipine-benazepril + Lithium Major
Frequently asked questions
Can I take Lithium with Sulindac?
MediHelp rates the interaction as major. Lithium 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. NSAIDs can raise serum lithium concentrations and precipitate lithium toxicity. Sulindac is considered to have less effect than other NSAIDs, but cases of raised lithium levels have been reported.
How serious is the interaction between Lithium 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: Check lithium levels within about a week of starting or changing the NSAID and reduce lithium dose as required. Monitor for tremor, nausea, confusion and ataxia, or choose an alternative analgesic.
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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