Salicylate Combination

A to Z Drug Facts

 Action Relieves pain by inhibiting prostaglandin synthesis and release; reduces fever by vasodilation of peripheral vessels. Unlike aspirin, does not inhibit platelet aggregation.

 Indications Relief of mild to moderate pain; treatment of rheumatic fever and rheumatoid arthritis including juvenile arthritis and osteoarthritis; management of fever.

 Contraindications Hypersensitivity to nonacetylated salicylates, NSAIDs or aspirin; advanced chronic renal insufficiency; bleeding disorders; GI bleeding.

 Route/Dosage

Inflammatory Conditions

ADULTS: PO 1500 mg bid or 3000 mg qd. ELDERLY PATIENTS: PO 750 mg tid.

Fever, Mild to Moderate Pain

ADULTS: PO 1000 to 1500 mg bid. CHILDREN < 37 KG: PO 50 mg/kg/day in 2 divided doses. CHILDREN > 37 KG: PO 2250 mg/day in 2 divided doses. Doses are adjusted based on patient's response, tolerance and serum salicylate concentration.

 Interactions

Carbonic anhydrase inhibitors (eg, acetazolamide): Accumulation of carbonic anhydrase inhibitor and toxicity. Corticosteroids: Decreased plasma salicylate concentration. Methotrexate: Could cause methotrexate toxicity. Oral hypoglycemics or insulin: Could cause hypoglycemia. Urinary acidifiers: Increased salicylate serum concentration. Urinary alkalinizers (eg, chronic antacids): Decreased salicylate serum concentration. Warfarin: Enhanced anticoagulant activity of oral anticoagulants. Creates potential for increased prothrombin time due to protein-binding displacement.

 Lab Test Interferences Phenolsulfonphthalein: Salicylates decrease renal excretion. Thyroid function tests: Drug causes increased free T₄ and decreased total T₄; thyroid function is not affected. Urine glucose: Drug causes false-negative results by glucose oxidase method and false-positive results by copper reduction method with moderate to high doses of salicylates. Urine 5-HIAA: Salicylates interfere with fluorescent method. Urine ketones: Drug causes interference with ferric chloride (Gerhardt) method by turning urine a reddish color. Urine vanillylmandelic acid: Salicylates can interfere with determination.

 Adverse Reactions

DERM: Hives; rash; angioedema. EENT: Tinnitus. GI: Nausea; dyspepsia; gastric ulceration. HEMA: Prolonged bleeding time. HEPA: Hepatotoxicity. META: Uric acid levels elevated by salicylate concentrations < 10 mg/dl and decreased by levels > 10 mg/dl. RESP: Bronchospasm. OTHER: Anaphylaxis; salicylism may occur with large doses or chronic therapy (symptoms include dizziness, tinnitus, vomiting, diarrhea, confusion, CNS depression, headache, sweating, hyperventilation and lassitude); fever.

 Precautions

Pregnancy: Category C. Do not use during third trimester; could prematurely close ductus arteriosus in the fetus. Lactation: Excreted in breast milk. Children: May increase risk of Reye's syndrome; do not use in individuals < 18 yr if chickenpox or flu symptoms are suspected. Special risk patients: Use drug with caution in patients with renal or hepatic dysfunction, peptic ulcer disease or gastritis. Aspirin or NSAID hypersensitivity: Nonacetylated salicylates have been tolerated in aspirin-sensitive asthmatic patients; however, cases of cross-sensitivity including bronchospasm have been reported.

 Administration/Storage

• May cause GI upset; take with food or after meals. Take with a full glass of water.
• Store in tight, light-resistant container.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess quality of pain (location, onset, type and duration) or temperature prior to therapy.
• Monitor pain relief and temperature after medication administration.
• Inspect affect joints. Assess mobility, swelling/deformities and skin condition.
• Monitor improvement during therapy (fever reduction, relief from joint tenderness and pain; increased movement).
• Assess areas of bruising prior to and during therapy. Report increased bruising immediately to physician.
• If tinnitus, flushing, tachycardia, hyperventilation, sweating or thirst occurs, withhold medication and immediately notify physician.
• Obtain baseline hepatic and renal studies and CBC, PT and PTT. Monitor periodically if patient is undergoing long-term therapy.
• Monitor salicylate serum levels as ordered by physician.

 Patient/Family Education

• Advise patient to take medication with food or after meals with full glass of water.
• Emphasize need to avoid alcohol ingestion and use of NSAIDs during therapy (which increase risk of GI irritation/GI bleeding), especially if patient is undergoing long-term therapy.
• Instruct patients with diabetes to monitor blood levels closely during treatment.
• Instruct patient to call physician immediately if ringing in ears or persistent GI pain occurs while taking this medication.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts