salsalate, Amigesic, Salflex, Argesic-SA, Marthritic, Salsitab, Artha-GDisalcid, Amigesic, Disalcid (cont.)

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PREPARATIONS: Tablets: 500, 750 mg

STORAGE: Salsalate should be stored at room temperature 15-0 C (59-86 F).

PRESCRIBED FOR: Salsalate is used for treating rheumatoid arthritis and osteoarthritis. It also is used for the treatment of inflammation and pain resulting from soft tissue injuries, tendinitis, bursitis, and similar conditions.

DOSING: The usual dose of salsalate is 3000 mg daily given over 2-4 doses. Salsalate should be taken with food to reduce stomach upset.

DRUG INTERACTIONS: Salsalate, like aspirin, is converted to salicylic acid. Therefore, adding aspirin to salsalate can cause salicylic acid toxicity.

NSAIDs may increase the blood levels of lithium (Eskalith) by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.

NSAIDs may reduce the blood pressure lowering effects of blood pressure medications. This may occur because prostaglandins play a role in the regulation (lowering) of blood pressure.

When NSAIDs are combined with methotrexate (Rheumatrex, Trexall) or aminoglycosides (for example, gentamicin) the blood levels of methotrexate or aminoglycoside may increase, presumably because the elimination of methotrexate or aminoglycosides is reduced. This may lead to side effects from methotrexate or aminoglycosides.

PREGNANCY: There are no adequate studies of salsalate in pregnant women.

NURSING MOTHERS: Salicylic acid appears in breast milk at levels close to maternal blood levels. This may cause adverse effects in the infant. Nursing women should avoid nursing while taking salsalate or use alternate drugs.

SIDE EFFECTS: Most patients benefit from salsalate and other NSAIDs with few side effects. However, serious side effects can occur and generally tend to be dose-related (are more common at higher doses). Therefore, it is advisable to use the lowest effective dose to minimize side effects. The most common side effects of salsalate involve the gastrointestinal system and ringing in the ears (tinnitus). It can cause ulcerations of the stomach and intestines, abdominal pain, cramping, nausea, vomiting, gastritis, and even serious gastrointestinal bleeding and liver toxicity. Sometimes, ulceration and bleeding may occur without any abdominal pain. Black tarry stools, weakness, and dizziness upon standing (orthostatic hypotension) may be the only signs of internal bleeding. Patients who develop tinnitus may need to reduce the dose of salsalate. Rash, kidney impairment, vertigo, and lightheadedness also may occur. Fluid retention, blood clots, heart attacks, hypertension, and heart failure also have been associated with the use of NSAIDs.

Reference: FDA Prescribing Information

Last Editorial Review: 3/27/2009

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