Comparative Pharmacology
Head-to-head clinical analysis: ARTHROTEC versus SULINDAC.
Peer-Reviewed Evidence
Head-to-head clinical analysis: ARTHROTEC versus SULINDAC.
ARTHROTEC vs SULINDAC
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Arthrotec is a combination of diclofenac, a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX-1 and COX-2) enzymes, reducing prostaglandin synthesis, and misoprostol, a synthetic prostaglandin E1 analog that protects the gastric mucosa by increasing mucus and bicarbonate secretion, enhancing mucosal blood flow, and promoting epithelial repair.
Non-selective cyclooxygenase (COX-1 and COX-2) inhibitor, reducing prostaglandin synthesis. Prodrug converted to active sulfide metabolite which inhibits COX enzymes.
One tablet (diclofenac 50 mg / misoprostol 200 mcg) orally twice daily with food.
150-200 mg orally twice daily, with maximum daily dose 400 mg.
None Documented
None Documented
Clinical Note
moderateSulindac + Digitoxin
"Sulindac may decrease the cardiotoxic activities of Digitoxin."
Clinical Note
moderateSulindac + Deslanoside
"Sulindac may decrease the cardiotoxic activities of Deslanoside."
Clinical Note
moderateSulindac + Acetyldigitoxin
"Sulindac may decrease the cardiotoxic activities of Acetyldigitoxin."
Clinical Note
moderateSulindac + Ouabain
"Sulindac may decrease the cardiotoxic activities of Ouabain."
Diclofenac: ~2 hours (range 1-4 h); misoprostol: 20-40 minutes (acid metabolite 1.5 h). No accumulation with repeated dosing.
14 hours (sulfide active metabolite); 3-4 hours (parent sulindac). Steady-state attained in 3-4 days.
Renal: ~95% as metabolites (diclofenac: ~65% as glucuronide conjugates; misoprostol: ~80% as inactive metabolites). Biliary/fecal: <5%.
Primarily renal (about 50% as glucuronide conjugates, 25-30% as sulfide and sulfone metabolites); biliary/fecal elimination accounts for approximately 25-30%.
Category C
Category D/X
NSAID
NSAID