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Sulindac is a non-steroidal anti-inflammatory drug (NSAID) of the arylalkanoic acid class, primarily used to manage pain and inflammation associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. It is a prodrug that undergoes hepatic metabolism to form its active sulfide metabolite, which acts as a non-selective inhibitor of the cyclooxygenase (COX-1 and COX-2) enzymes, thereby reducing the synthesis of pro-inflammatory prostaglandins. A notable pharmacological feature of sulindac is its "renal-sparing" potential; because the active metabolite is oxidized back into the inactive sulfone form in the kidneys, it may have a reduced impact on renal prostaglandin synthesis compared to other NSAIDs, though clinical caution is still advised. Additionally, sulindac has been studied for its unique ability to inhibit the growth of precancerous colonic polyps. Common side effects align with the NSAID class, including gastrointestinal irritation and potential cardiovascular risks, requiring careful patient assessment before long-term use.
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