SalsalateRx

Trade Names:  Disalcid

Synonyms: Disalicylic acid

Drug Class: Nonacetylated salicylate, NSAID

Preparations
Tablets: 500 and 750 mg

Dose: Adult: 3 g/day in two or three divided doses

Indications: RA, osteoarthritis, pain

Mechanism of Action: Weak inhibitor of prostaglandin synthesis

Contraindications: Hypersensitivity to salicylates, acute coronary ischemia or peri-operative pain in setting of CABG

Precautions: Administer with food. Use caution in asthma, bleeding disorders, anticoagulant use, hepatic or renal disease or  high GI or CV risk, hypertension

Monitoring: Monitor hematocrit, creatinine, liver enzymes periodically (e.g.,1 month after starting and then every 3–6 months). Serum salicylate levels may be assayed periodically, if necessary.

Pregnancy Risk: C/D last  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, NSAIDs can increase CV risk and impair renal function, dose-related side effects include tinnitus and deafness.

Drug Interactions
Antacids: Decreased salicylate levels through increased elimination in alkaline urine
Anticoagulants: Activity of warfarin increased
Uricosurics: Decreased uricosuric effect

Patient Instructions: Take with food. Discontinue and seek medical advice if fainting, vomiting of blood, or unusual bleeding develops.

Comments: Nonacetylated salicylates have little effect on platelet function and may cause less GI toxicity than classic NSAIDs, which are more potent inhibitors of prostaglandin synthesis. In practice, the antiinflammatory effect of salsalate is less than that of classic NSAIDs.

Clinical Pharmacology: Rapidly and well absorbed; hepatic metabolism and renal excretion of conjugated metabolites. Wide variation in plasma concentrations in individuals receiving the same dose. Half-life varies with dose (2–3 hours with low doses, >20 hours with high doses) because at high doses the salicylate elimination pathway is saturated and a small increase in dose can lead to a large increase in serum concentrations.

Cost: $