Salsalate

What is Salsalate

Salsalate is a non-acetylated, nonsteroidal anti-inflammatory agent. Salsalate (salicylsalicylic acid) is composed of two molecules of salicylic acid joined by an ester link.

The ester bond of salsalate occurs at the carboxyl group of one salicylic acid molecule and the hydroxyl group of another. Salsalate has analgesic properties, but clinical evidence of its effectiveness as an antipyretic is lacking.

Salsalate is used in the treatment of osteoarthritis, rheumatoid arthritis, and other inflammatory conditions.

It has fewer gastrointestinal effects than aspirin and has no clinically significant effect on platelet function. Salsalate was FDA-approved in 1977.

Brand Names

  • Amigesic
  • Argesic-SA
  • Disalcid
  • Mono Gesic
  • Salflex

Indications

  • osteoarthritis
  • rheumatoid arthritis

Side Effects

  1. abdominal pain
  2. acneiform rash
  3. agranulocytosis
  4. anaphylactoid reactions
  5. anemia
  6. angioedema
  7. aplastic anemia
  8. azotemia
  9. bronchospasm
  10. confusion
  11. constipation
  12. dehydration
  13. diaphoresis
  14. diarrhea
  15. disseminated intravascular coagulation (DIC)
  16. dizziness
  17. drowsiness
  18. elevated hepatic enzymes
  19. encephalopathy
  20. erythema nodosum
  21. fever
  22. gastritis
  23. GI bleeding
  24. GI perforation
  25. hallucinations
  26. headache
  27. hearing loss
  28. hepatic necrosis
  29. hepatitis
  30. hyperbilirubinemia
  31. hyperglycemia
  32. hypernatremia
  33. hypertension
  34. hyperuricemia
  35. hyperventilation
  36. hypoglycemia
  37. hypokalemia
  38. hypoprothrombinemia
  39. jaundice
  40. lethargy
  41. leukocytosis
  42. leukopenia
  43. lichen planus-like eruption
  44. maculopapular rash
  45. metabolic acidosis
  46. myocardial infarction
  47. nausea
  48. pancytopenia
  49. peptic ulcer
  50. proteinuria
  51. pruritus
  52. pulmonary edema
  53. purpura
  54. pyrosis (heartburn)
  55. rash
  56. renal papillary necrosis
  57. renal tubular necrosis
  58. respiratory depression
  59. Reye’s syndrome
  60. seizures
  61. stroke
  62. thrombocytopenia
  63. thromboembolism
  64. tinnitus
  65. urticaria
  66. vertigo
  67. visual impairment
  68. vomiting
  69. wheezing

Monitoring Parameters

  • glucose-6-phosphate dehydrogenase (G6PD) activity
  • serum creatinine/BUN
  • serum salicylate concentrations
  • stool guaiac

Contraindications

  • acid/base imbalance
  • acute bronchospasm
  • alcoholism
  • anemia
  • angina
  • anticoagulant therapy
  • ascites
  • asthma
  • bone marrow suppression
  • breast-feeding
  • cardiac disease
  • cerebrovascular disease
  • children
  • coagulopathy
  • coronary artery bypass graft surgery (CABG)
  • corticosteroid therapy
  • dehydration
  • edema
  • esophagitis
  • G6PD deficiency
  • gastritis
  • geriatric
  • GI bleeding
  • GI disease
  • GI perforation
  • gout
  • heart failure
  • hemophilia
  • hepatic disease
  • hypertension
  • hyperuricemia
  • hypoprothrombinemia
  • hypothyroidism
  • hypovolemia
  • immunosuppression
  • infection
  • influenza
  • jaundice
  • labor
  • metabolic acidosis
  • metabolic alkalosis
  • myocardial infarction
  • nasal polyps
  • neutropenia
  • NSAID hypersensitivity
  • obstetric delivery
  • peptic ulcer disease
  • peripheral vascular disease
  • pregnancy
  • renal disease
  • renal failure
  • renal impairment
  • respiratory acidosis
  • respiratory alkalosis
  • Reye’s syndrome
  • salicylate hypersensitivity
  • stroke
  • systemic lupus erythematosus (SLE)
  • thromboembolism
  • thrombolytic therapy
  • thrombotic thrombocytopenic purpura (TTP)
  • tobacco smoking
  • varicella
  • viral infection
  • vitamin K deficiency

Interactions

  • Acetaminophen
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Codeine
  • Acetaminophen; Dextromethorphan
  • Acetaminophen; Dextromethorphan; Doxylamine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Diphenhydramine
  • Acetaminophen; Guaifenesin; Phenylephrine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Pentazocine
  • Acetaminophen; Propoxyphene
  • Acetaminophen; Pseudoephedrine
  • Acetaminophen; Tramadol
  • Acetazolamide
  • Acetohexamide
  • Acidifying Agents
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Aliskiren; Hydrochlorothiazide, HCTZ
  • Alkalinizing Agents
  • Alogliptin
  • Alogliptin; Metformin
  • Alogliptin; Pioglitazone
  • Alpha-glucosidase Inhibitors
  • Amiloride
  • Amiloride; Hydrochlorothiazide, HCTZ
  • Aminoglycosides
  • Amlodipine; Benazepril
  • Amlodipine; Celecoxib
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amphotericin B
  • Amphotericin B cholesteryl sulfate complex (ABCD)
  • Amphotericin B lipid complex (ABLC)
  • Amphotericin B liposomal (LAmB)
  • Angiotensin-converting enzyme inhibitors
  • Antithrombin III
  • Antithymocyte Globulin
  • Apixaban
  • Ardeparin
  • Ascorbic Acid, Vitamin C
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Atenolol; Chlorthalidone
  • Azilsartan; Chlorthalidone
  • Bacitracin
  • Barbiturates
  • Benazepril
  • Benazepril; Hydrochlorothiazide, HCTZ
  • Bendroflumethiazide; Nadolol
  • Benzhydrocodone; Acetaminophen
  • Beta-blockers
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • Bromocriptine
  • Bumetanide
  • Calcium Carbonate
  • Calcium Carbonate; Magnesium Hydroxide
  • Calcium Carbonate; Risedronate
  • Calcium Carbonate; Simethicone
  • Canagliflozin
  • Canagliflozin; Metformin
  • Candesartan; Hydrochlorothiazide, HCTZ
  • Capreomycin
  • Captopril
  • Captopril; Hydrochlorothiazide, HCTZ
  • Cefixime
  • Cefotetan
  • Celecoxib
  • Chlorothiazide
  • Chlorpropamide
  • Chlorthalidone
  • Chlorthalidone; Clonidine
  • Cidofovir
  • Citalopram
  • Citric Acid; Potassium Citrate
  • Citric Acid; Potassium Citrate; Sodium Citrate
  • Citric Acid; Sodium Citrate
  • Colchicine; Probenecid
  • Colistimethate, Colistin, Polymyxin E
  • Corticosteroids
  • Cyclosporine
  • Dabigatran
  • Dalteparin
  • Dapagliflozin
  • Dapagliflozin; Metformin
  • Dapagliflozin; Saxagliptin
  • Daratumumab; Hyaluronidase
  • Deferasirox
  • Dichlorphenamide
  • Diclofenac
  • Diclofenac; Misoprostol
  • Diflunisal
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Doravirine; Lamivudine; Tenofovir disoproxil fumarate
  • Drotrecogin Alfa
  • Edoxaban
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Empagliflozin
  • Empagliflozin; Linagliptin
  • Empagliflozin; Linagliptin; Metformin
  • Empagliflozin; Metformin
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Emtricitabine; Tenofovir disoproxil fumarate
  • Enalapril, Enalaprilat
  • Enalapril; Felodipine
  • Enalapril; Hydrochlorothiazide, HCTZ
  • Enoxaparin
  • Eprosartan; Hydrochlorothiazide, HCTZ
  • Ertugliflozin; Metformin
  • Ertugliflozin; Sitagliptin
  • Escitalopram
  • Esomeprazole; Naproxen
  • Ethacrynic Acid
  • Ethanol
  • Ethotoin
  • Etodolac
  • Famotidine; Ibuprofen
  • Fenoprofen
  • Flavocoxid, Flavocoxid; Citrated Zinc Bisglycinate
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Flurbiprofen
  • Fluvoxamine
  • Fondaparinux
  • Foscarnet
  • Fosinopril
  • Fosinopril; Hydrochlorothiazide, HCTZ
  • Fosphenytoin
  • Furosemide
  • Gallium Ga 68 Dotatate
  • Glimepiride
  • Glimepiride; Pioglitazone
  • Glimepiride; Rosiglitazone
  • Glipizide
  • Glipizide; Metformin
  • Glyburide
  • Glyburide; Metformin
  • Griseofulvin
  • Heparin
  • Hyaluronidase
  • Hyaluronidase, Recombinant; Immune Globulin
  • Hydralazine; Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ; Irbesartan
  • Hydrochlorothiazide, HCTZ; Lisinopril
  • Hydrochlorothiazide, HCTZ; Losartan
  • Hydrochlorothiazide, HCTZ; Methyldopa
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Moexipril
  • Hydrochlorothiazide, HCTZ; Olmesartan
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrochlorothiazide, HCTZ; Quinapril
  • Hydrochlorothiazide, HCTZ; Spironolactone
  • Hydrochlorothiazide, HCTZ; Telmisartan
  • Hydrochlorothiazide, HCTZ; Triamterene
  • Hydrochlorothiazide, HCTZ; Valsartan
  • Hydrocodone; Ibuprofen
  • Ibritumomab Tiuxetan
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Immune Globulin IV, IVIG, IGIV
  • Incretin Mimetics
  • Indapamide
  • Inotersen
  • Insulins
  • Ketoprofen
  • Ketorolac
  • Lamivudine; Tenofovir Disoproxil Fumarate
  • Lansoprazole; Naproxen
  • Linagliptin
  • Linagliptin; Metformin
  • Lisinopril
  • Lithium
  • Loop diuretics
  • Low Molecular Weight Heparins
  • Macimorelin
  • Mannitol
  • Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meglitinides
  • Meloxicam
  • Metformin
  • Metformin; Pioglitazone
  • Metformin; Repaglinide
  • Metformin; Rosiglitazone
  • Metformin; Saxagliptin
  • Metformin; Sitagliptin
  • Methazolamide
  • Methotrexate
  • Methyclothiazide
  • Metolazone
  • Moexipril
  • Mycophenolate
  • Nabumetone
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Nateglinide
  • Nitazoxanide
  • Omeprazole; Sodium Bicarbonate
  • Oxaprozin
  • Paroxetine
  • Penicillins
  • Pentosan
  • Perindopril
  • Perindopril; Amlodipine
  • Phentermine; Topiramate
  • Phenytoin
  • Photosensitizing agents (topical)
  • Pioglitazone
  • Piroxicam
  • Polymyxins
  • Potassium Bicarbonate
  • Potassium Chloride
  • Potassium Citrate
  • Pramlintide
  • Probenecid
  • Psyllium
  • Quinapril
  • Ramipril
  • Repaglinide
  • Rituximab; Hyaluronidase
  • Rivaroxaban
  • Rosiglitazone
  • Salicylic Acid
  • Saxagliptin
  • Selective serotonin reuptake inhibitors
  • Serotonin norepinephrine reuptake inhibitors
  • Sertraline
  • Simvastatin; Sitagliptin
  • Sitagliptin
  • Sodium Bicarbonate
  • Sodium Hyaluronate, Hyaluronic Acid
  • Sodium Lactate
  • Sodium Thiosulfate; Salicylic Acid
  • Spironolactone
  • Sulfinpyrazone
  • Sulfonamides
  • Sulfonylureas
  • Sulindac
  • Tacrolimus
  • Telavancin
  • Tenofovir Alafenamide
  • Tenofovir, PMPA
  • Thiazide diuretics
  • Thiazolidinediones
  • Thrombin Inhibitors
  • Thrombolytic Agents
  • Tinzaparin
  • Tolazamide
  • Tolbutamide
  • Tolmetin
  • Topiramate
  • Torsemide
  • Trandolapril
  • Trandolapril; Verapamil
  • Trastuzumab; Hyaluronidase
  • Trazodone
  • Treprostinil
  • Triamterene
  • Tromethamine
  • Valproic Acid, Divalproex Sodium
  • Vancomycin
  • Varicella-Zoster Virus Vaccine, Live
  • Vilazodone
  • Vortioxetine
  • Warfarin