salsalate (sal´s
lāt),drug class: salicylate, nonnarcotic analgesic;
action: blocks formation of peripheral prostaglandins, which cause pain and inflammation; antipyretic action results from inhibition of hypothalamic heat-regulating center; does not inhibit platelet aggregation;
uses: treatment of mild to moderate pain or fever, including arthritis and juvenile rheumatoid arthritis.
salsalate
Amigesic, Salflex
Pharmacologic class: Salicylate
Therapeutic class: Nonopioid analgesic, anti-inflammatory
Pregnancy risk category C
Action
Breaks down into salicylic acid, which lowers elevated body temperature by dilating peripheral vessels. Also reduces inflammation and relieves pain, probably by inhibiting prostaglandin synthesis.
Availability
Tablets: 500 mg, 750 mg
⊘Indications and dosages
➣ Rheumatoid arthritis; nonarticular rheumatism; osteoarthritis; polyarthritis
Adults: Initially, 1 g P.O. t.i.d., titrated as needed
Contraindications
• Hypersensitivity to salicylates, other nonsteroidal anti-inflammatory drugs (NSAIDs), or tartrazine
• Hemophilia
• Bleeding ulcers
• Hemorrhagic states
• Blood coagulation defects
• Children and adolescents with viral infections
Precautions
Use cautiously in:
• severe renal disease, hepatic damage, asthma, rhinitis, nasal polyps, hypoprothrombinemia, vitamin K deficiency, chronic alcohol use or abuse
• history of GI bleeding or ulcer disease
• elderly patients
• pregnant (especially during third trimester) or breastfeeding patients.
Administration
• Give with food to minimize GI upset.
☞ Don't administer to children or adolescents with viral infections, because of increased risk of Reye's syndrome.
| Route | Onset | Peak | Duration |
| P.O. | 5-30 min | 1-3 hr | 3-6 hr |
Adverse reactions
CNS: drowsiness, dizziness, confusion, headache, stimulation, hallucinations, depression, seizures, coma
CV: rapid pulse
EENT: hearing loss, tinnitus, laryngeal edema
GI: nausea, vomiting, dyspepsia, epigastric distress, heartburn, abdominal pain, anorexia, GI bleeding
Hematologic: hemolytic anemia, leukopenia, agranulocytosis, thrombocytopenia
Hepatic: hepatitis, hepatotoxicity
Metabolic: hyponatremia, hypokalemia, hypoglycemia
Respiratory: wheezing, hyperpnea, pulmonary edema
Skin: rash, flushing, urticaria, bruising, angioedema
Other: salicylism, Reye's syndrome, anaphylaxis
Interactions
Drug-drug. Activated charcoal: decreased salsalate absorption
Angiotensin-converting enzyme inhibitors: decreased antihypertensive effect
Antacids, urinary alkalizers: decreased salsalate efficacy
Beta-adrenergic blockers, probenecid, spironolactone, sulfinpyrazone, sulfonylureas: decreased effects of these drugs
Carbonic anhydrase inhibitors: increased risk of salicylism
Cefamandole, clopidogrel, eptifibatide, heparin, oral anticoagulants, plicamycin, thrombolytics, ticlopidine, tirofiban: increased bleeding
Corticosteroids: increased excretion and decreased blood level of salsalate
Insulin, oral hypoglycemics, penicillin, phenytoin, sulfonamide, valproic acid: increased effects of these drugs
Methotrexate: increased methotrexate blood level and risk of toxicity
NSAIDs: decreased NSAID blood level, increased risk of adverse GI effects
Vancomycin: increased risk of ototoxicity
Drug-diagnostic tests. Activated partial thromboplastin time, bleeding time, prothrombin time: increased
Alanine aminotransferase, alkaline phosphatase, amylase, aspartate aminotransferase, carbon dioxide, coagulation studies, uric acid, urinary protein: increased levels
Cholesterol, potassium, protein-bound iodine: decreased levels
Erythrocyte survival time: reduced
Pregnancy test, protirelin-induced thyroid-stimulating hormone test, radionuclide thyroid imaging, uric acid, urine catecholamines, urine glucose, urine hydroxyindoleacetic acid, urine ketone tests using ferric chloride method, urine vanillylmandelic acid: interference with test results
Drug-food. Urine-acidifying foods: increased salsalate blood level
Drug-herbs. Anise, arnica, chamomile, clove, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng, horse chestnut, kelp ware, licorice: increased risk of bleeding
Drug-behaviors. Alcohol use: increased risk of GI bleeding
Patient monitoring
• Monitor for signs and symptoms of anaphylaxis.
• Assess hearing and neurologic status.
• Monitor liver function tests, coagulation studies, and electrolyte and glucose levels.
• Assess for bleeding tendency and angioedema.
Patient teaching
☞ Teach patient to recognize and immediately report signs or symptoms of severe hypersensitivity reaction.
☞ Caution parents not to give drug to child with symptoms of viral illness.
☞ Instruct patient to immediately report unusual bleeding or bruising.
• Tell patient that many common herbs increase risk of bleeding. Advise him to consult prescriber before using.
• Caution patient to avoid alcohol, which increases risk of GI bleeding.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.
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