Sulindac

Sulindac is a prodrug. Its active metabolite is, like diclofenac, an acetic acid derivative. The drug is effective only after it is converted by liver enzymes to a sulfide, which is excreted in bile and then reabsorbed from the intestine. The enterohepatic cycling prolongs the duration of action to 12-16 hours. The indications and adverse reactions are similar to those of other NSAIDs. Among the more severe reactions, Stevens-Johnson epidermal necrolysis syndrome, thrombocytopenia, agranulocytosis, and nephrotic syndrome have all been observed. Like diclofenac, sulindac may have some propensity to cause elevation of serum aminotransferase; it is also sometimes associated with cholestatic liver damage.