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June 3, 1983

Sulindac and Renal Impairment

Author Affiliations

The Johns Hopkins University School of Medicine Baltimore

JAMA. 1983;249(21):2892. doi:10.1001/jama.1983.03330450024017

To the Editor.—  We noted the article by Drs Bunning and Barth, which suggests that sulindac may be used with safety in patients who have previously manifested evidence of renal impairment while receiving other nonsteroidal anti-inflammatory drugs (NSAIDs) (1982;248:2864). We agree with their statement that this clinical recommendation should be viewed as preliminary, especially in view of the short duration of sulindac therapy used in their patients and the increase in serum creatinine clearance and decrease in creatinine clearance noted during sulindac therapy in the third of their three patients.It is of unquestionable pathophysiological interest that, unlike other NSAIDs, sulindac does not decrease urinary prostaglandin excretion. However, a recent patient of ours who was initially seen with sulindacinduced renal failure, interstitial nephritis, and nephrotic syndrome had a clinical course and predisposing risk factors (severe congestive heart failure) similar to those in the nephrotoxic reactions reported with the other NSAIDs.