Choline magnesium trisalicylate

Choline magnesium trisalicylate is a Non-steroidal anti-inflammatory drugs (NSAIDs)belonging to Anti-inflammatory.

Choline magnesium trisalicylate is a non-acetylated salicylate used widely as a nonsteroidal anti-inflammatory drug. Trisalicylate significantly reduces methotrexate renal clearance, displacing methotrexate from protein, increasing the fraction unbound by 28%.

Choline magnesium trisalicylate shows common side effects like Upset stomach, vomiting, heartburn, diarrhea, constipation, stomach pain, headache, lightheadedness, dizziness, drowsiness, lack of energy.

Choline magnesium trisalicylate is available in the form of Oral tablet and Oral solution.

Choline magnesium trisalicylate is available in India, US, UK, Canada, Philippines, China, Japan, Malaysia, Switzerland, and Australia.

Choline magnesium trisalicylate is an Anti-inflammatory belonging to the class Non-steroidal anti-inflammatory drugs (NSAIDs).

Choline magnesium trisalicylate inhibits prostaglandin synthesis; acts on the hypothalamus heat-regulating center to reduce fever; blocks the generation of pain impulses.

The amount of time required for Choline magnesium trisalicylate to show its action about 1-2 hours.

Choline magnesium trisalicylate is available in the form of Oral tablet and Oral solution.

Choline magnesium trisalicylate tablet and solution is taken orally, usually every 8 to 12 hours.

Choline salicylate is used for the treatment of mouth ulcers (painful sores on the inner lining of your mouth). It also provides relief from redness, swelling and tenderness that may be associated with wearing dentures (removable replacements for missing teeth) or dental braces (wire-based appliances used to correct crowded and misaligned teeth).

Choline magnesium trisalicylate is a Non-steroidal anti-inflammatory drugs (NSAIDs) belonging to Anti-inflammatory.

Choline salicylate alleviates pain by inhibition of prostaglandin synthesis and reduce fever by acting on the hypothalamus heat-regulating center. It also blocks the generation of impulses.

Choline magnesium trisalicylate is approved for use in the following clinical indications

• Osteoarthritis, Rheumatoid Arthritis and Acute Painful Shoulder
• Analgesic and Antipyretic Action

• Osteoarthritis, Rheumatoid Arthritis and Acute Painful Shoulder

Adult oral dose: 1000-3000 mg every 8-12 hours.

• Analgesic and Antipyretic Action

Adult oral dose: 1000-1500 mg every 12 hours.

Choline magnesium trisalicylate is available in various strengths as 500mg/5mL, 500mg, 750mg and 1000mg.

Choline magnesium trisalicylate is available in the form of Oral tablet and Oral solution.

Choline magnesium trisalicylate is contraindicated in patients with

• Hypersensitivity to choline magnesium trisalicylate, other non-acetylated salicylates, or any component of the formulation.

• Gastrointestinal (GI) adverse effects

Nausea, vomiting, gastric upset, indigestion, heartburn, diarrhea, constipation, and/or epigastric pain may occur frequently.

• Tinnitus

Tinnitus is a common adverse effect; may indicate toxicity; reduce dose until tinnitus resolves.

• Asthma

Use with caution in patients with asthma. Non-acetylated salicylate products are associated with cross reactivity in aspirin-sensitive patients, although choline magnesium trisalicylate has been demonstrated to be well tolerated (with respect to respiratory symptoms) in patients with aspirin-sensitive asthma.

• Gastrointestinal disease

Use with caution in patients with gastritis or peptic ulcer disease. Avoid coadministration with ethanol; may enhance GI adverse effects, including GI bleeding.

• Hepatic impairment

Use with caution in patients with acute or chronic hepatic impairment.

• Renal impairment

Use with caution in patients with acute or chronic renal impairment.

Salicylate is excreted in human milk. Because of the potential for significant salicylate absorption by the nursing infant, caution should be exercised when choline magnesium trisalicylate is administered to a nursing woman.

Animal reproduction studies have not been conducted with Choline magnesium trisalicylate preparations. It is also not known whether Choline magnesium trisalicylate can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Choline magnesium trisalicylate should be given to a pregnant woman only if clearly needed. Because of the known effects of other salicylate drug products on the fetal cardiovascular system use during late pregnancy should be avoided.

• Common

Constipation, diarrhea, dyspepsia, epigastric pain, heartburn, nausea, vomiting, Tinnitus, Central nervous system: Dizziness, drowsiness, headache, lethargy, Auditory impairment.

• Rare

Anorexia, asthma, bruise, confusion, duodenal ulcer, dysgeusia, edema, epistaxis, erythema multiforme, esophagitis, gastric ulcer, hallucination, hearing loss (irreversible), increased blood urea nitrogen, increased liver enzymes, increased serum creatinine, occult blood in stools, pruritus, skin rash, weight gain.

• Agents with Blood Glucose Lowering Effects

Salicylates may enhance the hypoglycemic effect of Agents with Blood Glucose Lowering Effects.

• Ajmaline

Salicylates may enhance the adverse/toxic effect of Ajmaline. Specifically, the risk for cholestasis may be increased.

• Ammonium Chloride

May increase the serum concentration of Salicylates.

Angiotensin-Converting Enzyme Inhibitors: Salicylates may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Salicylates may diminish the therapeutic effect of Angiotensin-Converting Enzyme Inhibitors.

• Benzbromarone

Salicylates may diminish the therapeutic effect of Benzbromarone.

• Carbonic Anhydrase Inhibitors

Salicylates may enhance the adverse/toxic effect of Carbonic Anhydrase Inhibitors. Salicylate toxicity might be enhanced by this same combination. Management: Avoid these combinations when possible.Dichlorphenamide use with high-dose aspirin as contraindicated. If another combination is used, monitor patients closely for adverse effects. Tachypnea, anorexia, lethargy, and coma have been reported.

• Corticosteroids (Systemic)

Salicylates may enhance the adverse/toxic effect of Corticosteroids (Systemic). These specifically include gastrointestinal ulceration and bleeding. Corticosteroids (Systemic) may decrease the serum concentration of Salicylates. Withdrawal of corticosteroids may result in salicylate toxicity.

• Ginkgo Biloba

May enhance the anticoagulant effect of Salicylates. Management: Consider alternatives to this combination of agents. Monitor for signs and symptoms of bleeding (especially intracranial bleeding) if salicylates are used in combination with ginkgo biloba.

• Hyaluronidase

Salicylates may diminish the therapeutic effect of Hyaluronidase.

• Loop Diuretics

Salicylates may diminish the therapeutic effect of Loop Diuretics. Loop Diuretics may increase the serum concentration of Salicylates.

• Methotrexate

Salicylates may increase the serum concentration of Methotrexate. Salicylate doses used for prophylaxis of cardiovascular events are not likely to be of concern. Management: Consider avoiding coadministration of methotrexate and salicylates. If coadministration cannot be avoided, monitor for increased toxic effects of methotrexate. Salicylate doses used for prophylaxis of cardiovascular events are not likely to be of concern.

• Nonsteroidal Anti-Inflammatory Agents (Topical)

May enhance the adverse/toxic effect of Salicylates. Specifically, the risk of gastrointestinal (GI) toxicity is increased. Management: Coadministration of salicylates and topical NSAIDs is not recommended. If salicylates and topical NSAIDs are coadministered, ensure the benefits outweigh the risks and monitor for increased NSAID toxicities.

• Pralatrexate

Salicylates may increase the serum concentration of Pralatrexate. Salicylate doses used for prophylaxis of cardiovascular events are unlikely to be of concern. Management: Consider avoiding concomitant use of salicylates and pralatrexate. If coadministered, monitor for increased pralatrexate adverse effects. Salicylate doses used for prophylaxis of cardiovascular events are not likely to be of concern.

• Probenecid

Salicylates may diminish the therapeutic effect of Probenecid.

• Salicylates

May enhance the anticoagulant effect of other Salicylates.

• Sulfinpyrazone

Salicylates may decrease the serum concentration of Sulfinpyrazone.

• Thrombolytic Agents

Salicylates may enhance the adverse/toxic effect of Thrombolytic Agents. An increased risk of bleeding may occur.

• Valproate Products

Salicylates may increase the serum concentration of Valproate Products.

• Vitamin K Antagonists (eg, warfarin)

Salicylates may enhance the anticoagulant effect of Vitamin K Antagonists. Management: Avoid as needed use of salicylates in patients taking vitamin K antagonists. Aspirin (80 to 325 mg/day) may be used with warfarin for prevention of cardiovascular events. If coadministering salicylates and vitamin K antagonists, monitor for bledding.

The common side effects of Choline magnesium trisalicylate include the following

• Common side effects

Upset stomach, vomiting, heartburn, diarrhea, constipation, stomach pain, headache, lightheadedness, dizziness, drowsiness, lack of energy.

• Rare side effects

Ringing in the ears, hearing loss, black and tarry stools, red blood in stools, bloody vomit.

• Pregnancy

Pregnancy Category C

Animal reproduction studies have not been conducted with Choline magnesium trisalicylate preparations. It is also not known whether Choline magnesium trisalicylate can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Choline magnesium trisalicylate should be given to a pregnant woman only if clearly needed. Because of the known effects of other salicylate drug products on the fetal cardiovascular system use during late pregnancy should be avoided.

• Nursing Mothers

Salicylate is excreted in human milk. Peak milk salicylate levels are delayed, occurring as long as 9 to 12 hours post dose, and the milk: plasma ratio has been reported to be as high as 0.34. Because of the potential for significant salicylate absorption by the nursing infant, caution should be exercised when choline magnesium trisalicylate is administered to a nursing woman.

Symptoms

Salicylate intoxication, known as salicylism, may occur with large doses or extended therapy. Common symptoms of salicylism include headache, dizziness, tinnitus, hearing impairment, confusion, drowsiness, sweating, vomiting, diarrhea, and hyperventilation. A more severe degree of salicylate intoxication can lead to CNS disturbances, alterationin electrolyte balance, respiratory and metabolic acidosis, hyperthermia, and dehydration.

Treatment

Reduction of further absorption of salicylate from the gastrointestinal tract can be achieved via emesis, gastric lavage, use of activated charcoal, or a combination of the above. Appropriate I.V. fluids should be administered to correct dehydration, electrolyte imbalance, and acidosis and to maintain adequate renal function. To accelerate salicylate excretion, forced diuresis with alkalinizing solution is recommended. In extreme cases, peritoneal dialysis or hemodialysis should be considered for effective salicylate removal.

• Pharmacodynamic

Trisalicylate-choline is a non-steroidal anti-inflammatory drug (NSAID) that contains a combination of choline salicylate and magnesium salicylate. Does not affect platelet aggregation.

• Pharmacokinetics

Absorption

Choline magnesium trisalicylate is Rapidly absorbed from stomach and small intestine.Time taken to reach peak plasma concentration is generally 1 to 2 hours.

Distribution

Choline magnesium trisalicylate Readily distributes into most body fluids and tissues. Its Protein binding is 90% to 95%.

Metabolism and Excretion

Conjugated to glycine and glucuronide metabolites, the glycine conjugation pathway is rapidly saturated at higher doses. It is Primarily excreted via Urine (major route) primarily as metabolites and 10% as unchanged drug)also excreted via bile (minor route).

• https://www.drugs.com/mtm/choline-magnesium-trisalicylate.html
• https://medlineplus.gov/druginfo/meds/a602021.html#:~:text=Choline magnesium trisalicylate is used,relieve pain and lower fever.
• https://www.uptodate.com/contents/choline-magnesium-trisalicylate-united-states-not-available-drug-information?search=choline magnesium trisalicylate&source=panel_search_result&selectedTitle=1~8&usage_type=panel&kp_tab=drug_general&display_rank=1
• https://www.rxlist.com/trilisate-drug.htm#interactions
• https://go.drugbank.com/drugs/DB01401