choline and magnesium salicylates

choline and magnesium salicylates

(koe-leen mag-neez-ee-um sal-i-sil-ates) cholinemagnesiumsalicylates,

Trilisate

(trade name)

Classification

Therapeutic: antipyretics
Pharmacologic: salicylates
Pregnancy Category: C
Pregnancy Category: D
(third trimester)

Indications

Inflammatory disorders including:
  • Rheumatoid arthritis,
  • Osteoarthritis.
Mild to moderate pain.Fever.

Action

Produce analgesia and reduce inflammation and fever by inhibiting the production of prostaglandins.

Therapeutic effects

Analgesia.Reduction of inflammation.Reduction of fever.

Pharmacokinetics

Absorption: Well absorbed after oral administration.Distribution: Rapidly and widely distributed; crosses the placenta and enters breast milk.Protein Binding: 90–95%.Metabolism and Excretion: Extensively metabolized by the liver; inactive metabolites excreted by the kidneys. Amount excreted unchanged by the kidneys depends on urine pH; as pH increases, amount excreted unchanged increases from 2–3% up to 80%.Half-life: 2–3 hr for low doses; up to 15–30 hr with larger doses because of saturation of liver metabolism.

Time/action profile

ROUTEONSETPEAKDURATION
PO5–30 min1–3 hr3–6 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to aspirin or other salicylates; Cross-sensitivity with other NSAIDs may exist (less with nonaspirin salicylates).Use Cautiously in: History of GI bleeding or ulcer disease; Chronic alcohol use/abuse; Severe renal disease (magnesium toxicity may occur); Severe hepatic disease; Obstetric: Salicylates may have adverse effects on fetus and mother; should be avoided during pregnancy, especially during the 3rd trimester; Lactation: Safety not established; Pediatric: May increase the risk of Reye’s syndrome in children or adolescents recovering from chickenpox or flu symptoms; Geriatric: ↑ risk of adverse reactions especially GI bleeding; more sensitive to toxic levels.

Adverse Reactions/Side Effects

Ear, Eye, Nose, Throat

  • tinnitus

Gastrointestinal

  • GI bleeding (life-threatening)
  • dyspepsia (most frequent)
  • epigastric distress (most frequent)
  • nausea (most frequent)
  • abdominal pain
  • anorexia
  • hepatotoxicity
  • vomiting

Miscellaneous

  • allergic reactions including anaphylaxis and laryngeal edema (life-threatening)

Interactions

Drug-Drug interaction

May ↑ activity of penicillins, phenytoin, methotrexate, valproic acid, oral hypoglycemic agents, and sulfonamides.May ↓ beneficial effects of probenecid.Urinary acidification ↑ reabsorption and may ↑ serum salicylate levels.Alkalinization of the urine or the ingestion of large amounts of antacids ↑ excretion and ↓ serum salicylate levels.May blunt the therapeutic response to diuretics or other antihypertensives.↑ risk of GI irritation with NSAIDs.May increase hypoprothrombinemic effect of warfarin.Foods capable of acidifying the urine (see ) may ↑ serum salicylate levels.

Route/Dosage

5 mL of liquid equivalent to 500 mg salicylate or 650 mg of aspirin. Tablet strength expressed in mg of salicylate: 500-mg tablet equivalent to 650 mg of aspirin, 750-mg tablet equivalent to 975 mg of aspirin, 1000-mg tablet equivalent to 1.3 g of aspirinOral (Adults) Analgesic/antipyretic—2–3 g of salicylate/day in 2–3 divided doses.Anti-inflammatory—3 g/day at bedtime or in 2–3 divided doses.Oral (Children ) 30–60 mg/kg/day given in 3–4 divided doses.

Availability

Tablets: 500 mg, 750 mg, 1000 mg Liquid: 500 mg/5 mL

Nursing implications

Nursing assessment

  • Patients who have asthma, allergies, and nasal polyps or who are allergic to tartrazine are at an increased risk for developing hypersensitivity reactions.
  • Pain: Assess pain and limitation of movement; note type, location, and intensity before and at the peak (see Time/Action Profile) after administration.
  • Fever: Assess fever and note associated signs (diaphoresis, tachycardia, malaise, chills).
  • Lab Test Considerations: Monitor hepatic function before antirheumatic therapy and if symptoms of hepatotoxicity occur; more likely in patients, especially children, with rheumatic fever, systemic lupus erythematosus, juvenile arthritis, or pre-existing hepatic disease. May cause ↑ serum AST, ALT, and alkaline phosphatase, especially when plasma concentrations exceed 25 mg/100 mL. May return to normal despite continued use or dose reduction. If severe abnormalities or active liver disease occurs, discontinue and use with caution in future.
    • Monitor serum salicylate levels periodically with prolonged high-dose therapy to determine dose, safety, and efficacy, especially in children with Kawasaki disease.
    • May alter results of serum uric acid, urine vanillylmandelic acid (VMA), protirelin-induced thyroid-stimulating hormone (TSH), urine hydroxyindoleacetic acid (5-HIAA) determinations, and radionuclide thyroid imaging.
    • Monitor patient for the onset of tinnitus, headache, hyperventilation, agitation, mental confusion, lethargy, diarrhea, and sweating. If these symptoms appear, withhold medication and notify physician or other health care professional immediately.

Potential Nursing Diagnoses

Acute pain (Indications)
Impaired physical mobility (Indications)

Implementation

  • Use lowest effective dose for shortest period of time.
  • Oral: Administer after meals or with food or an antacid to minimize gastric irritation. Food slows but does not alter the total amount absorbed.

Patient/Family Teaching

  • Instruct patient to take salicylates with a full glass of water and to remain in an upright position for 15–30 min after administration.
    • Advise patient to report tinnitus; unusual bleeding of gums; bruising; black, tarry stools; or fever lasting longer than 3 days.
    • Caution patient to avoid concurrent use of alcohol with this medication to minimize possible gastric irritation; 3 or more glasses of alcohol per day may increase the risk of GI bleeding. Caution patient to avoid taking concurrently with acetaminophen or NSAIDs for more than a few days, unless directed by health care professional to prevent analgesic nephropathy.
    • Tablets with an acetic (vinegar-like) odor should be discarded.
    • Advise patients on long-term therapy to inform health care professional of medication regimen before surgery. Salicylates may need to be withheld for 1 wk before surgery.

Evaluation/Desired Outcomes

  • Relief of mild to moderate discomfort.
  • Increased ease of joint movement. May take 2–3 wk for maximum effectiveness.
  • Reduction of fever.