TEALE FENNING

toyin2 · Joined: 18 Jan 2008 Posts: 29 Location: London

Q. Sulindac is to be avoided in pregnancy
A. True

now i know its an NSAID which should be avoided in preg but we used it at the john radcliffe silver star team quite often to treat symptomatic polyhydramnios.
Also according to Catherine Nelson-Piercy's handbook(which is a bible Very Happy

)sometimes u gotta use NSAIDs to control arthritis pain if steroids dont work eg in ankylosing spondylitis but always stop them by 32-34wks.

SO...what answer do u all think the "RCOG" want?? Evil or Very Mad

by the way,this question was not form the rcog pastpaper book but another well known course Wink

PS i know it only one question,one mark but we need all the marks we can get right? Embarassed

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

i see your point -- and i will go with True, one should avoid it.

Drug safety guidelines class it as a Category D drug.

[Category D:

There is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).]

Sulindac has been used in preg in preterm labour, medical management of polyhydramnios, and in severe arthritis where other analgesics fail to work.

there is risk of reduced foetal renal function, premature closure of ductus arteriosus, low birth wt babies etc but all these are seen much less frequently than in use of indomethacin.
no foetal structural anomalies have been observed in use of sulindac.

so i guess it's better avoided but one can use it with proper precautions and patient counseling - regular growth scans and dopplers and be ready to deliver early if any worries. i.e get the balancing act right.

r
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

some interesting facts about sulindac are --

it's a pro drug and converts to active metabolite in liver

it's a Cox 1 and Cox 2 co-enzyme and that's how it acts as a prostaglandin synthetase inhibitor to give the NSAID action

sulindac is not metabolised in the placenta

it reduces growth of polyps and other bowel precancer lesions and is used in familial adenomatous polyps for it's anticancer properties

it has anti Alzheimer properties that are under trial currently.

Smile

_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

Maud · Joined: 11 Oct 2007 Posts: 73 Location: Bristol

toyin2 · Joined: 18 Jan 2008 Posts: 29 Location: London

thanks Raj and Maud Cool

oh the joys of mcq's huh?!