II. Mechanism

  1. History
    1. Willow bark and wintergreen leaves contain Salicin (Salicylic acid)
      1. Used for thousands of years for pain and fever
      2. Salicylic acid was first lab synthesized in the 1840s
      3. Salicylic acid was acetylated to the more palatable Acetylsalicylic Acid (Aspirin) in the 1850s
    2. Salicylates have been used for pain, fever and rheumatic diseases for more than 100 years
      1. NSAIDs developed over time as a class of Aspirin-like drugs
      2. Most Salicylates are metabolized to the active salicylic acid
  2. Salicylates have antipyretic, Analgesic and anti-inflammatory properties
    1. Blocks cyclooxygenase (COX, esp. COX1)
    2. Inhibits conversion of Arachidonic Acid to Prostaglandin precursors
    3. Decreasing Prostaglanding levels results in decreased fever, pain and inflammation
  3. Salicylates (esp. Aspirin) also have antiplatelet activity

III. Medications

  1. Acetylsalicylic Acid (Aspirin)
    1. Analgesic Dosing: 500-1000 mg every 4-6 hours
  2. Other less commonly used Salicylates
    1. Trisalicylate (Trilisate)
      1. Dosing 1000-1500 mg every 8-12 hours
    2. Diflunisal (Dolobid) 500 mg every 8-12 hours
      1. Risk of Acute Interstitial Nephritis
      2. Compared with Aspirin, lower risk of Gastrointestinal Bleeding, Tinnitus
    3. Salsalate (Disalcid)
      1. Arthritis (OA, RA): 3000 mg/day divided every 8 to 12 hours
  3. Other Salicylates not in use medically
    1. Sodium Salicylate (Uracil 5)
    2. Sodium thiosalicylate (Tusal)
      1. Thimerosal (historically a Vaccine preservative) is a Mercury compound derived from thiosalicylic acid

IV. Adverse Effects

  1. Gastrointestinal upset
  2. Gastrointestinal Bleeding
  3. Tinnitus
  4. Hypersensitivity
  5. Serious skin reactions (e.g. Stevens-Johnson Syndrome)

V. Safety

  1. Avoid Salicylates in general in Lactation
  2. Most Salicylates, as with NSAIDs are legacy system Pregnancy category C (except Category D in third trimester)
    1. Aspirin is used in pregnancy for Preeclampsia Prevention
  3. However Salicylates and NSAIDs have significant risks in pregnancy
    1. See NSAID for pregnancy-related risks that also apply to Salicylates
    2. Salicylates have specifically been found to have adverse effects in pregnancy
      1. Anemia
      2. Anti-partum Hemorrhage
      3. Post-partum Hemorrhage
      4. Prolonged gestation
      5. Complicated deliveries
      6. Perinatal mortality
      7. Collins (1975) Lancet 2(7930):335-8 +PMID: 51142 [PubMed]

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Ontology: Salicylates (C0036077)

Definition (MSH) The salts or esters of salicylic acids, or salicylate esters of an organic acid. Some of these have analgesic, antipyretic, and anti-inflammatory activities by inhibiting prostaglandin synthesis.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D012459
SnomedCT 9203006, 350312004
LNC LP16276-5, MTHU005042
English Salicylates, salicylates, salicylates (medication), Salicylates [Chemical/Ingredient], products salicylates, Salicylate (product), Salicylate, Salicylate product, Salicylate product (product), Salicylate, NOS, Salicylate (substance), Salicylate product (substance)
Swedish Salicylater
Czech salicylany, salicyláty
Finnish Salisylaatit
Russian SALITSILATY, САЛИЦИЛОВЫЕ КИСЛОТЫ, SALITSILOVYE KISLOTY, САЛИЦИЛАТЫ
Spanish salicilato, salicilato, producto (producto), salicilato (producto), salicilato, producto, salicilato (sustancia), salicilato, producto (sustancia), Salicilatos
Polish Salicylany, Kwasu salicylowego pochodne
Croatian SALICILATI
Norwegian Not Translated[Salicylates]
French Salicylates
German Salicylate
Italian Salicilati
Portuguese Salicilatos