Choline Magnesium TrisalicylateRx

Trade Names: Trilisate, Tricosal

Drug Class: Nonacetylated salicylate, NSAID

Preparations
Liquid: 500 mg/5 mL
Tablets: 500-, 750-, 1000 mg

Dose: Adult: 500 mg to 1.5 g, two or three times daily; usual maintenance dose, 1.0–4.5 g/day

Indications: RA, osteoarthritis

Mechanism of Action: Weak inhibitor of prostaglandin synthesis

Contraindications: Hypersensitivity to salicylates

Precautions: Administer with food. Use caution in asthma, bleeding disorders, and hepatic or renal disease.

Monitoring: Monitor hematocrit, creatinine, LFTs  (1 month after starting and then periodically). Periodically check serum magnesium with high-dose therapy or in the presence of impaired renal function.

Pregnancy Risk: C/D third trimester

Adverse Effects
Common: GI irritation (dyspepsia, reflux, epigastric pain)
Less common: GI ulceration or hemorrhage; minor elevations of liver enzymes; hypersensitivity (asthma, urticaria, angioedema, particularly in patients with nasal polyps). Cross-sensitivity occurs between NSAIDs, but hypersensitivity is less common with the nonacetylated salicylates. Dose-related side effects include tinnitus and deafness.

Drug Interactions
Antacids: Decreased salicylate levels because of increased elimination in alkaline urine
Anticoagulants: Activity of warfarin is increased

Patient Instructions: Take with food. Discontinue and seek medical advice if unusual bleeding occurs.

Comments: Magnesium may accumulate in patients with renal impairment. Serum salicylate concentrations of 150–300 mcg/mL are antiinflammatory. Nonacetylated salicylates have little effect on platelet function and cause less GI toxicity than classical NSAIDs, which are more potent inhibitors of prostaglandin synthesis.

Clinical Pharmacology: See Aspirin

Cost: $