CHOLINE MAGNESIUM TRISALICYLATE

CHOLINE MAGNESIUM TRISALICYLATE
(cho'leen mag-ne'si-um tri-sal'i-ci-late)
Trilisate
Classifications: analgesic (salicylate), nonsteroidal antiinflammatory drug (nsaid); antipyretic;
Therapeutic:nsaid, analgesic (salicylate)

Prototype: Aspirin
Pregnancy Category: C first and second trimester; D third trimester

Availability

500 mg, 750 mg, 1000 mg tablets; 500 mg/5 mL liquid

Action

Choline magnesium trisalicylate is a nonsteroidal, antiinflammatory preparation combining choline salicylate and magnesium salicylate. Mode of action is by inhibiting prostaglandin synthesis by reversibly inhibiting cyclooxygenase (both COX-1 and COX-2), resulting in its antiinflammatory properties as well as its analgesic property.

Therapeutic Effect

Has antiinflammatory, analgesic, and antipyretic action. Platelet aggregation is not affected.

Uses

Osteoarthritis, rheumatoid arthritis, and other arthrides. Preferable to aspirin for patients with GI bleeding.

Contraindications

Hypersensitivity to nonacetylated salicylates; children <6 y; children and teenagers with chickenpox, influenza, or flu symptoms because of the potential for Reye's syndrome; coagulopathy, anticoagulant therapy, G6PD deficiency; pregnancy (category C first and second trimester and category D in third trimester); contraindicated in late pregnancy, near term, or in labor and delivery.

Cautious Use

Chronic renal and hepatic failure, history of GI disease, peptic ulcer; patients on coumadin or heparin, anemia; hypovolemic states; lactation; older adults.

Route & Dosage

Arthritis
Adult: PO 1.5–2.5 g/d in 1–3 divided doses (max: 4.5 g/d)

Mild to Moderate Pain, Fever
Adult: PO 2–3 g/d in 2 divided doses
Child: PO 30–60 mg/kg/d in 3–4 divided doses

Administration

Oral
  • Give with food to reduce gastric upset. Do not give with antacids.
  • Store at 59°–86° F (15°–30° C).

Adverse Effects (≥1%)

GI: Vomiting, diarrhea. CNS: Headache, vertigo, confusion, drowsiness. Special Senses: Tinnitus.

Interactions

Drug: Aminosalicylic acid increases risk of salicylate toxicity; ammonium chloride and other acidifying agents decrease its renal elimination, increasing risk of salicylate toxicity; anticoagulants increase risk of bleeding; carbonic anhydrase inhibitors enhance salicylate toxicity; corticosteroids compound ulcerogenic effects; increases methotrexate toxicity; low doses of salicylates may antagonize uricosuric effects of probenecid, sulfinpyrazone.

Pharmacokinetics

Absorption: Readily absorbed from small intestine. Onset: 30 min. Peak: 1–3 h. Metabolism: In liver. Elimination: In urine. Half-Life: 2–3 h.

Nursing Implications

Assessment & Drug Effects

  • As with other NSAIDs, the antipyretic and antiinflammatory effects may mask usual S&S of infection or other diseases.
  • Assess for GI discomfort; nausea, gastric irritation, indigestion, diarrhea, and constipation are frequent complaints.
  • Monitor for S&S of bleeding. Closely monitor PT if used concurrently with warfarin.

Patient & Family Education

  • Avoid taking aspirin, NSAIDs, or acetaminophen concurrently with drug.
  • Avoid dangerous activities until reaction to drug is determined, due to possible CNS effects (e.g., vertigo, drowsiness).
  • Report tinnitus or persistent gastric irritation and epigastric pain.
  • Report any unexplained bruising or bleeding to physician.
  • Hypoglycemic effects may be enhanced for those with type 2 diabetes taking an oral hypoglycemic agent (OHA).
  • Do not give to children or teenagers with chickenpox, influenza, or flu symptoms because of association with Reye's syndrome.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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