Yes

Salicylate

Treatment of minor pain or fever; arthritis

C (D in 3rd trimester)

GI ulcer or bleeding, known hypersensitivity to salsalate

Use with caution in patients with platelet and bleeding disorders, renal dysfunction, erosive gastritis, or peptic ulcer disease, dehydration, previous nonreaction does not guarantee future safe taking of medication; do not use aspirin in children <16 years of age for chickenpox or flu symptoms due to the association with Reye's syndrome

>10%: Gastrointestinal: Nausea, heartburn, stomach pains, dyspepsia

1% to 10%:

Central nervous system: Fatigue

Dermatologic: Rash

Gastrointestinal: Gastrointestinal ulceration

Hematologic: Hemolytic anemia

Neuromuscular & skeletal: Weakness

Respiratory: Dyspnea

Miscellaneous: Anaphylactic shock

<1%: Insomnia, nervousness, jitters, leukopenia, thrombocytopenia, iron deficiency anemia, does not appear to inhibit platelet aggregation, occult bleeding, hepatotoxicity, impaired renal function, bronchospasm

Symptoms of overdose include respiratory alkalosis, hyperpnea, tachypnea, tinnitus, headache, hyperpyrexia, metabolic acidosis, hypoglycemia, coma. The "Done" nomogram is very helpful for estimating the severity of aspirin poisoning and directing treatment using serum salicylate levels.

Treatment should also be based upon symptomatology. Toxic symptoms and corresponding treatments are as follows:

• Overdose: Induce emesis with ipecac, and/or lavage with saline, followed with activated charcoal
• Dehydration: I.V. fluids with KCl (no D₅W only)
• Metabolic acidosis (must be treated): Sodium bicarbonate
• Hyperthermia: Cooling blankets or sponge baths
• Coagulopathy/hemorrhage: Vitamin K I.V.
• Hypoglycemia (with coma, seizures, or change in mental status): Dextrose 25 g I.V.
• Seizures: Diazepam 5-10 mg I.V.

Decreased effect with urinary alkalinizers, antacids, corticosteroids; decreased effect of uricosurics, spironolactone; ACE-inhibitor effects may be decreased by concurrent therapy with NSAIDs

Increased effect/toxicity of oral anticoagulants, hypoglycemics, methotrexate

Inhibits prostaglandin synthesis, acts on the hypothalamus heat-regulating center to reduce fever, blocks prostaglandin synthetase action which prevents formation of the platelet-aggregating substance thromboxane A₂

Onset of action: Therapeutic effects occur within 3-4 days of continuous dosing

Absorption: Oral: Completely from the small intestine

Metabolism: Hydrolyzed in the liver to 2 moles of salicylic acid (active)

Half-life: 7-8 hours

Elimination: Almost totally excreted renally

Adults: Oral: 3 g/day in 2-3 divided doses

May be administered with food to decrease GI distress

False-negative results for glucose oxidase urinary glucose tests (Clinistix®); false-positives using the cupric sulfate method (Clinitest®); also, interferes with Gerhardt test, VMA determination; 5-HIAA, xylose tolerance test and T₃ and T₄

May cause drowsiness; may rarely cause nervousness or insomnia

May rarely cause leukopenia; use caution with clozapine and carbamazepine

No information available to require special precautions

NSAID formulations are known to reversibly decrease platelet aggregation via mechanisms different than observed with aspirin. The dentist should be aware of the potential of abnormal coagulation. Caution should also be exercised in the use of NSAIDs in patients already on anticoagulant therapy with drugs such as warfarin (Coumadin®).

Take this medication exactly as directed; do not increase dose without consulting prescriber. Do not crush tablets or break capsules. Take with food or milk to reduce GI distress. Maintain adequate fluid intake (2-3 L/day of fluids unless instructed to restrict fluid intake). Do not use alcohol, aspirin, or aspirin-containing medication, and all other anti-inflammatory medications without consulting prescriber. You may experience drowsiness (use caution when driving or engaging in tasks requiring alertness until response to drug is known); nausea or heartburn (frequent small meals, frequent mouth care, sucking lozenges, or chewing gum may help). GI bleeding, ulceration, or perforation can occur with or without pain; discontinue medication and contact prescriber if persistent abdominal pain or cramping, or blood in stool occurs. Report breathlessness or difficulty breathing; unusual bruising/bleeding; blood in urine, stool, mouth, or vomitus; unusual fatigue; skin rash or itching; change in urinary pattern; or change in hearing or ringing in ears. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Do not breast-feed.

Does not appear to inhibit platelet aggregation

Capsule: 500 mg

Tablet: 500 mg, 750 mg

Chapman BJ and Proudfoot AT, "Adult Salicylate Poisoning: Deaths and Outcome in Patients With High Plasma Salicylate Concentrations," Q J Med, 1989, 72(268):699-707.

Dugandric RM, Tierney MG, and Dickinson GE, "Evaluation of the Done Nomogram in the Management of Acute Salicylate Intoxication," Ann Emerg Med, 1989, 18(11):1186-90.

Gurwitz JH, Avorn J, Ross-Degnan D, et al, "Nonsteroidal Anti-Inflammatory Drug-Associated Azotemia in the Very Old," JAMA, 1990, 264(4):471-5.

Hawkey CJ, Karrasch JA, Szczepanski L, et al, "Omeprazole Compared With Misoprostrol for Ulcers Associated With Nonsteroidal Anti-inflammatory Drugs," N Engl J Med, 1998, 338(11):727-34.

Spontak SF, Hassan FM, and Spadafora MP, "Salsalate Intoxication and Ramifications of Utilizing Nonspecific Analytical Methods in Estimating Quantitative Blood Concentrations," J Anal Toxicol, 1994, 18(4):229-31.

Vandenberg SA, Smolinske SC, Spoerke DG, et al, "Nonaspirin Salicylates: Conversion Factors for Estimating Aspirin Equivalency," Vet Hum Toxicol, 1989, 31(1):49-50.

Verbeeck RK, "Pharmacokinetic Drug Interactions With Nonsteroidal Anti-inflammatory Drugs," Clin Pharmacokinet, 1990, 19(1):44-66.

Vertrees JE, McWilliams BC, and Kelly HW, "Repeated Oral Administration for Treating Aspirin Overdose in Young Children," Pediatrics, 1990, 85(4):594-8.

Weissmann G, "Aspirin," Sci Am, 1991, 264(1):84-90.

Yeomans ND, Tulassay Z, Juhasz L, et al, "A Comparison of Omeprazole With Ranitidine for Ulcers Associated With Nonsteroidal Anti-inflammatory Drugs," N Engl J Med, 1998, 338(11):719-26.