Dosing and uses of Trilisate ASA combination (choline magnesium trisalicylate)
Adult dosage forms and strengths
liquid
- 500mg/5mL (294 mg choline salicylate, 362 mg magnesium salicylate)
tablet
- 500mg (294 mg choline salicylate, 362 mg magnesium salicylate)
- 750mg (440 mg choline salicylate, 544 mg magnesium salicylate)
- 1000mg (587 mg choline salicylate, 725 mg magnesium salicylate)
Osteoarthritis
1000-3000 mg PO q8-12hr
Rheumatoid Arthritis
1000-3000 mg PO q8-12hr
Fever
1000-1500 mg PO q12hr
Renal Impairment
Avoid use in severe renal impairment
Other Indications & Uses
Shoulder pain
Pediatric dosage forms and strengths
liquid
- 500mg/5mL salicylate (294 mg choline salicylate, 362 mg magnesium salicylate)
tablet
- 500mg salicylate (294 mg choline salicylate, 362 mg magnesium salicylate)
- 750mg salicylate (440 mg choline salicylate, 544 mg magnesium salicylate)
- 1000mg salicylate (587 mg choline salicylate, 725 mg magnesium salicylate)
Mild to Moderate Pain
<37 kg: 50 mg/kg PO divided q12hr
>37 kg: 2250 mg PO divided q12hr
Fever
<37 kg: 50 mg/kg PO divided q12hr
>37 kg: 2250 mg PO divided q12hr
Geriatric dosage forms and strengths
Osteoarthritis
750 mg PO q8hr
Rheumatoid arthritis
500-1500 mg PO q8-12hr
Trilisate ASA combination (choline magnesium trisalicylate) adverse (side) effects
Frequency not defined
GI pain/ulceration/bleeding
Tinnitus, hearing loss
Hepatotoxicity
Renal damage
Premature hemolysis
CNS alteration
Pulmonary edema (salicylate-induced/noncardiogenic)
Dermatologic problems, urticaria
Angioedema
Bronchospasm
Warnings
Contraindications
Absolute: bleeding disorders, chronic advanced renal insufficiency, GI hemorrhage, hemorrhagic diathesis, salicylate allergy
Relative: Erosive gastritis, GI ulcer, NOs
Cautions
Anemia, gout, hepatic function impairment, hypertension, hypoprothrombinemia, nasal polyps, renal function impairment, thyrotoxicosis, vitamin K deficiency
Use of salicylates in pediatric pts with varicella or influenza-like illness is associated with incr incidence of Reye's Syndrome
Pregnancy and lactation
Pregnancy category: C; D if used for prolonged periods or near term
Lactation: excreted in human breast milk; adverse effect on the nursing infant
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Trilisate ASA combination (choline magnesium trisalicylate)
Mechanism of action
Inhibits cyclooxygenase; [at least 2 isoenzymes, cyclooxygenase-1 (COX-1) and -2 (COX-2)], thereby inhibiting prostaglandin synthesis
Pharmacokinetics
Half-Life: 2-3 hr (low-dose); 15-30 hr (high dose)
Duration: 3-6 hr (PO); >7 hr (PR)
Onset: 5-30 min (PO); 1-2 hr (PR)
Peak Plasma: 2 hr (PO); 4-5 hr (PR)
Vd: 0.15-0.2 L/kg
Metabolism: Liver, microsomal enzyme system
Metabolites: Salicylurate, salicyl phenolic glucuronide, salicyl acyl glucuronide, 2,5-dihydroxybenzoic acid (gentisic acid), 2,3-dihydroxybenzoic acid, 2,3,5-trihydroxybenzoic acid, gentisuric acid (active)
Clearance: 24-72 hr
Excretion: Principally in urine (80-100%), sweat, saliva, feces
Dialyzable: Yes
Enzymes inhibited: Prostaglandin synthesis (insignificant)
Concentration
- Analgesia and antipyresis 30-100 mcg/mL
- Anti-inflammatory effect 150-300 mcg/mL
- Rheumatic fever 250-350 mcg/mL
Protein Bound
- 90-95% with concentrations up to 100 mcg/mL
- 70-85% with concentrations up to 100-400 mcg/mL
- 25-60% with higher concentrations