Comparison Table: Naproxen vs. Sulindac
| Category | Naproxen | Sulindac |
|---|---|---|
| 1. Drug Class | NSAID (Nonsteroidal Anti-Inflammatory Drug) | NSAID (Nonsteroidal Anti-Inflammatory Drug) |
| 2. Common Brand Names | Aleve, Naprosyn, Anaprox | Clinoril |
| 3. Mechanism of Action | Non-selective COX-1 and COX-2 inhibitor | Prodrug; converted in liver to active form inhibiting COX-1 and COX-2 |
| 4. Half-Life | 12–17 hours | 7–8 hours |
| 5. Onset of Action | 1 hour | 1–2 hours |
| 6. Duration of Action | 8–12 hours | 6–12 hours |
| 7. Dosage Forms | Tablets, capsules, suspension | Tablets |
| 8. Common Dose Range | 250–500 mg twice daily | 150–200 mg twice daily |
| 9. Food Requirements | Take with food or milk to reduce GI upset | Take with food to reduce GI irritation |
| 10. Approved Uses | Pain, arthritis, gout, menstrual cramps, tendinitis | Arthritis, gout, ankylosing spondylitis |
| 11. Off-label Uses | Bursitis, fever, migraine | Familial adenomatous polyposis (FAP), bursitis |
| 12. GI Risk | Moderate to high | Higher than naproxen |
| 13. Cardiovascular Risk | Moderate; lower than some NSAIDs | Higher cardiovascular risk in some studies |
| 14. Renal Risk | Can reduce kidney function with long-term use | Similar renal toxicity risk |
| 15. Hepatic Metabolism | Partially hepatic | Extensively hepatic (prodrug converted in liver) |
| 16. Pediatric Use | Approved in children over 2 years | Not recommended under 18 years |
| 17. Pregnancy Category | C (1st & 2nd trimester), D (3rd trimester) | C (1st & 2nd trimester), D (3rd trimester) |
| 18. Black Box Warning | GI bleeding, CV events, ulcer risk | GI bleeding, CV events, ulcer risk |
| 19. Drug Interactions | Warfarin, lithium, diuretics, ACE inhibitors | Warfarin, lithium, diuretics, methotrexate |
| 20. Cost/Availability | Widely available, inexpensive (OTC and Rx) | Rx only; less commonly used, more expensive |
📌 Indications
| Naproxen | Sulindac |
|---|---|
| – Osteoarthritis | – Osteoarthritis |
| – Rheumatoid arthritis | – Rheumatoid arthritis |
| – Ankylosing spondylitis | – Ankylosing spondylitis |
| – Tendinitis, bursitis | – Bursitis |
| – Gout flares | – Gout flares |
| – Dysmenorrhea | – Familial adenomatous polyposis (FAP) (off-label) |
| – Mild to moderate pain, fever | – Pain and inflammation |
🚫 Contraindications
| Naproxen | Sulindac |
|---|---|
| – Hypersensitivity to naproxen or other NSAIDs | – Hypersensitivity to sulindac or NSAIDs |
| – History of GI bleeding or ulcers | – History of GI bleeding or perforation |
| – Severe heart failure or recent cardiac surgery | – Severe cardiovascular disease |
| – Advanced renal disease | – Severe hepatic impairment |
| – Active peptic ulcer disease | – NSAID-induced asthma or anaphylaxis |
💊 Dosage (Adults)
| Naproxen | Sulindac |
|---|---|
| Initial: 250–500 mg twice daily | 150–200 mg twice daily |
| Max: 1500 mg/day (short-term use) | Max: 400 mg/day |
⚠️ Warning Signs / When to Stop the Drug
| Common to Both NSAIDs |
|---|
| – Severe stomach pain, black or bloody stools (GI bleeding) |
| – Chest pain, shortness of breath (heart attack or stroke symptoms) |
| – Swelling of face or limbs, signs of allergic reaction |
| – Unusual fatigue, dark urine, yellowing of skin or eyes (liver problems) |
| – Sudden weight gain, edema, decreased urine output (kidney issues) |
| – Vision changes, headache, or dizziness (CNS effects) |
✅ Which One is Best and Safer?
| Criteria | Best Option | Explanation |
|---|---|---|
| GI Safety | Naproxen | Slightly lower GI complication rate when used with food |
| CV Safety | Naproxen | Associated with lower cardiovascular risk than sulindac |
| Kidney Risk | Similar risk | Both should be used cautiously in renal impairment |
| Hepatic Safety | Naproxen | Sulindac has higher liver metabolism burden; riskier in liver dysfunction |
| Pain Relief Speed | Naproxen | Slightly faster onset in pain relief |
| Availability/Cost | Naproxen | Widely available over-the-counter and cheaper |
| Special Indications | Sulindac | Better for familial adenomatous polyposis (FAP) |
Conclusion: ✅ Naproxen is generally safer and more versatile for most people due to its better cardiovascular profile, fewer hepatic concerns, lower GI risk, and availability. However, Sulindac may be chosen in specific conditions like FAP or when naproxen is not tolerated.
