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Salicylate CombinationPronouncation: (suh-LIS-ih-late)
Class: CNS agent
Mechanism of Action
Relieves pain by inhibiting prostaglandin synthesis and release; reduces fever by vasodilation of peripheral vessels. Unlike aspirin, does not inhibit platelet aggregation.
Salicylate is absorbed rapidly and reaches C max in approximately 1 to 2 hr after a single dose of a tablet or liquid doseform.
The primary salicylate metabolites are glycine and glucuronide conjugates.
The primary route of excretion of salicylate is renal. Serum salicylate concentrations are increased by conditions that decrease glomerular filtration rate or proximal tubular secretion. Salicylate t ½ is approximately 9 to 17 hr.
Indications and Usage
Relief of mild-to-moderate pain; treatment of rheumatic fever and rheumatoid arthritis including juvenile arthritis and osteoarthritis; management of fever.
Hypersensitivity to nonacetylated salicylates, NSAIDs or aspirin; advanced chronic renal insufficiency; bleeding disorders; GI bleeding.
Dosage and AdministrationInflammatory Conditions
PO 1500 mg bid or 3000 mg qd.Elderly Patients
PO 750 mg tid.Fever, Mild-to-Moderate Pain
PO 1000 to 1500 mg bid.Children under 37 kg
PO 50 mg/kg/day in 2 divided doses.Children over 37 kg
PO 2250 mg/day in 2 divided doses. Doses are adjusted based on patient"s response, tolerance and serum salicylate concentration.
Store in tight, light-resistant container.
Drug InteractionsCarbonic 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.
Laboratory Test InteractionsPhenolsulfonphthalein
Salicylates decrease renal excretion.Thyroid function tests
Drug causes increased free T 4 and decreased total T 4 ; 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.
Hives; rash; angioedema.
Nausea; dyspepsia; gastric ulceration.
Prolonged bleeding time.
Uric acid levels elevated by salicylate concentrations less than 10 mg/dL and decreased by levels greater than 10 mg/dL.
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.
Category C . Do not use during third trimester; could prematurely close ductus arteriosus in the fetus.
Excreted in breast milk.
May increase risk of Reye"s syndrome; do not use in individuals under 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.
Respiratory alkalosis, hyperpnea, tachypnea, nausea, vomiting, hypokalemia, tinnitus, neurologic abnormalities (disorientation, irritability, lethargy, stupor), dehydration, hyperthermia, seizures, coma.
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