Last updated: October 22, 2014
Trade Names: Disalcid
Synonyms: Disalicylic acid
Drug Class: Nonacetylated salicylate, NSAID
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
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.
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.