Salsalate (COX 1 Inhibitors and NSAIDs)

Salsalate is classified as Non-steroidal anti-inflammatory drug (NSAIDs) in Salicylate group. Salsalate rapidly absorbed in intestine and also rapidly eliminated in 3.5 to6 6 hours. The maximum therapeutic effect is observed only after 3 to 4 days. Salicylates are COX 1 inhibitors and anti-inflammatory medications. Three medications Aspirin, Diflunisal and Salsalate are classified under salicylates group. Aspirin is most often used as an anti-inflammatory medication to prevent blocking of coronary artery inpatient suffering with coronary artery disease as well as treat pain and fever. Salsalate causes less of a gastric side effects resulting in gastropathy than naproxen.

Salsalate (COX 1 Inhibitors and NSAIDs)

  1. Alternative Name of Salsalate

    Salsalate is also known as Disalcid, Salsitab, and Salflex

  2. Mechanism of Action of Salsalate

    Salsalate is a weak cyclooxygenase inhibitor of prostaglandin. The medication also decreases secretion of interleukin-6 and TNF-alpha that is found in inflammatory tissue. Salsalate also inhibits IkB kinase enzyme which triggers the secretion of prostaglandin and C reactive protein. The inhibition of IkB kinase enzyme helps to sensitize insulin receptors resulting in decrease level of blood sugar when insulin is active at the receptors. Salsalate splits into two molecule following absorption in intestine.

  3. Uses: Salsalate is Used for Treatment of Following Symptoms-

    Pain- Salsalate is used for acute and chronic pain. Most acute nociceptive pain responds to salsalate. Chronic neuropathic pain often do not response to salsalate pills.

    Fever- Fever is treated with salsalate if not responding to aspirin. Salsalate dosage required to reduce fever may be higher than analgesic dosage.

    Inflammation- The tissue and joint inflammation responds to salsalate treatment. The pain intensity is also decreased if the spread of inflammation is reduced.

  4. Salsalate Used to Treat Following Diseases

  5. Dosage of Salsalate

    Salsalate is sold on shelf. The medication is available as pills and capsule. The strength of pills are 500 mg and 750 mg tablets. Pills are given 2 to 4 times a day depending on response of pain relief. Maximum dosage tolerated by adult is 3,000 mg.

  6. Duration of Action

    The pain relief is experienced 2 to 3 hours after the ingestion of pills. The pain relief lasts 3 to 6 hours following initial dosage. The maximum dosage used in children is 30 mg / kgm.

  7. Side Effects Caused by Salsalate

  8. Salsalate is Avoided in Patient Suffering with Following Diseases

    • Liver disease;
    • Abdominal pain;
    • Bronchial asthma;
    • Gout patient receiving uricosuric medications;
  9. Precaution Needed In Following Condition

    • Drug interaction- Lower dosage of Anesthetic medications, muscle relaxants and opioid analgesics needed to achieve therapeutic effects, since salicylic acid which are the metabolites of salsalate binds most of the serum protein.
    • Therapeutic dosage- Therapeutic dosage needed to lower blood pressure and blood sugar by antihypertensive and anti-diabetics is often lower.
    • Blood thinning medications- Dosage of warfarin may need to be adjusted if complications are observed.

References-

  1. Assessment of salsalate, a nonacetylated salicylate, in the treatment of patients with arthritis.

    Atkinson MH1, Ménard HA, Kalish GH.,

    Clin Ther. 1995 Sep-Oct;17(5):827-37.

  2. Reduced risk of NSAID gastropathy (GI mucosal toxicity) with nonacetylated salicylate (salsalate): an endoscopic study.

    Roth S1, Bennett R, Caldron P, Hartman R, Mitchell C, Doucette M, Ekholm B, Goldlust B, Lee E, Wilson R.

    Semin Arthritis Rheum. 1990 Feb;19(4 Suppl 2):11-9.

  3. Potentiation of Warfarin Associated with Salsalate Therapy Resulting in Bleeding.

    Rindone JP1, Mellen CK1.,

    Curr Drug Saf. 2018;13(2):141-143. doi: 10.2174/1574886313666180219165742.

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