Choline Magnesium Trisalicylate

U.S. Brand Names Tricosal®; Trilisate®

Use Management of osteoarthritis, rheumatoid arthritis, and other arthritis; salicylate salts may not inhibit platelet aggregation and, therefore, should not be substituted for aspirin in the prophylaxis of thrombosis; acute painful shoulder

Pregnancy Risk Factor C/D (3rd trimester)

Contraindications Hypersensitivity to salicylates, other nonacetylated salicylates, other NSAIDs, or any component of the formulation; tartrazine dye hypersensitivity; bleeding disorders; pregnancy (3rd trimester)

Warnings/Precautions Use with caution in patients with impaired renal function, dehydration, erosive gastritis, asthma, or peptic ulcer; avoid use in patients with suspected varicella or influenza (salicylates have been associated with Reye's syndrome in children <16 years of age when used to treat symptoms of chickenpox or the flu). Discontinue use 1 week prior to surgical procedures.

Elderly are a high-risk population for adverse effects from NSAIDs. As many as 60% of elderly can develop peptic ulceration and/or hemorrhage asymptomatically. Use lowest effective dose for shortest period possible. Tinnitus or impaired hearing may indicate toxicity. Tinnitus may be a difficult and unreliable indication of toxicity due to age-related hearing loss or eighth cranial nerve damage. CNS adverse effects may be observed in the elderly at lower doses than younger adults.

<20%:

<2%:

<1%: Gastric ulceration, occult bleeding, increased BUN and creatinine, rash, pruritus, anorexia, weight gain, edema, epistaxis, dysgeusia

Decreased effect: Antacids + Trilisate® decreased salicylate concentration; ACE-inhibitor effects may be decreased by concurrent therapy with NSAIDs

Increased toxicity: Warfarin + Trilisate® possible increased hypoprothrombinemic effect

Dosage Oral (based on total salicylate content):

Children <37 kg: 50 mg/kg/day given in 2 divided doses

Adults: 500 mg to 1.5 g 2-3 times/day; usual maintenance dose: 1-4.5 g/day

Dosing adjustment/comments in renal impairment: Avoid use in severe renal impairment

Liquid: 500 mg/5 mL total salicylate (293 mg/5 mL choline salicylate and 362 mg/5 mL magnesium salicylate)

Tablet: