salsalate

salsalate /sal·sa·late/ (sal´sah-lāt) a salicylate with analgesic, antipyretic, and anti-inflammatory actions; used in the treatment of osteoarthritis and rheumatoid arthritis.

---

salsalate [sal´sah-lāt]

an ester formed from two molecules of salicylic acid, used in treatment of rheumatoid arthritis and osteoarthritis.

---

salsalate (sal´slāt),

n brand names: Armigesic, Anaflex, Arthra-G, Mono-Gesic, Salflex, and Salsitab;
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.