sulindac and Bipolar-Disorder

Sulindac is a long-acting nonsteroidal anti-inflammatory drug (NSAID) widely used for the management of osteoarthritis, rheumatoid arthritis, ankylosing sponydlitis, and acute gouty arthritis. Reports of sulindac toxicity in the literature are rare. We report the case of a 22-year old male with a history of bipolar disorder who was brought to the emergency department after ingesting approximately 15 g of sulindac in a suicide attempt. He was found to have acute kidney injury and hyperbilirubinemia. Despite aggressive fluid resuscitation, his renal function progressively worsened requiring the initiation of hemodialysis. Ten days following ingestion of sulindac, he began to develop ischemic skin changes with a gangrenous appearance in his hands and feet. He continued to receive supportive treatment, and his acute kidney injury, hyperbillirubinemia, and ischemic skin necrosis eventually resolved. Clinicians should be aware of this long-acting NSAID and its ability to cause prolonged multisystem organ dysfunction.

Topics: Acute Kidney Injury; Anti-Inflammatory Agents, Non-Steroidal; Bipolar Disorder; Drug Overdose; Fluid Therapy; Humans; Hyperbilirubinemia; Ischemia; Male; Necrosis; Renal Dialysis; Resuscitation; Skin; Skin Diseases; Suicide, Attempted; Sulindac; Young Adult

Topics: Anti-Inflammatory Agents, Non-Steroidal; Bipolar Disorder; Comorbidity; Drug Therapy, Combination; Lithium; Pain; Sulindac

The interaction of sulindac with lithium was investigated in four patients who were admitted to a geropsychiatry ward and required lithium therapy. Sulindac 300 mg/day failed to affect lithium serum level and renal lithium clearance in these patients. Sulindac seems safer in patients receiving lithium than drugs like indomethacin, which can substantially increase serum lithium levels.

Topics: Bipolar Disorder; Drug Interactions; Humans; Indenes; Lithium; Male; Middle Aged; Psychotic Disorders; Sulindac