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Salsalate

Also indexed as: Amigesic®, Disalcid®, Marthritic®, Mono Gesic®, Salflex®, Salicylsalicylic acid, Salsitab®

Combination drug: Diprosalic®

Salsalate is used to treat rheumatoid arthritis and osteoarthritis and is in a class of medications known as non-steroidal anti-inflammatory drugs (NSAIDs).

Interactions with Dietary Supplements

Folic acid
Salsalate and aspirin produce anti-inflammatory effects after they are converted in the body to salicylic acid. Studies have shown that aspirin can reduce the amount of folic acid in the blood,1 though it is not known whether this change is significant. Controlled studies are needed to determine whether people taking salsalate are at risk for folic acid deficiency.

Lithium
Lithium is a mineral that may be present in some supplements and is also used in large amounts to treat mood disorders such as manic-depression (bipolar disorder). Most NSAIDs inhibit the excretion of lithium from the body, resulting in higher blood levels of the mineral, though sulindac may have an opposite effect.2 Since major changes in lithium blood levels can produce unwanted side effects or interfere with its efficacy, NSAIDs should be used with caution, and only under medical supervision, in people taking lithium supplements.

Potassium
Salsalate and aspirin are rapidly converted in the body to salicylic acid. Taking large amounts of aspirin can result in lower than normal blood levels of potassium,3 though it is not known whether this change is significant. Controlled studies are needed to determine whether people taking salsalate are at risk for potassium deficiency.

Vitamin C
Salsalate and aspirin are rapidly converted in the body to salicylic acid. Controlled studies show that taking aspirin increases the elimination of vitamin C from the body and lowers blood levels.4 Further controlled research is needed to determine whether salsalate specifically reduces vitamin C levels and whether people taking the drug are at risk for vitamin C deficiency.

Interactions with Herbs

Willow (Salix alba)
Willow bark contains salicin, which is related to aspirin. Salsalate, salicin, and aspirin produce anti-inflammatory effects after they have been converted to salicylic acid in the body. Taking aspirin at the same time as other salicylate drugs can result in adverse effects, such as ringing in the ears, dizziness, headache, confusion, and diarrhea.5 Though there are no studies specifically investigating an interaction between willow bark and salsalate, people taking salsalate should probably avoid using the herb until more information is available.

Interactions with Foods and Other Compounds

Food
Taking salsalate with food can slow the speed of absorption but not the overall amount of drug absorbed;6 therefore, it can be taken with a meal, if needed, to avoid stomach upset.

Summary of Interactions for Salsalate

Depletion or interference Folic acid*
Potassium*
Vitamin C*
Adverse interaction Lithium*
White willow*
Side effect reduction/prevention None known
Supportive interaction None known
Reduced drug absorption/bioavailability None known

For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

References:

1. Alter HJ, Zvaifler NJ, Rath CE. Interrelationship of rheumatoid arthritis, folic acid and aspirin. Blood 1971;38:405–16.

2. Olin BR, ed. Central Nervous System Drugs, Analgesics and Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172–90.

3. Smith MJH, Smith PK, eds. The Salicylates: A Critical Bibliographic Review. New York: Interscience, 1966.

4. Loh HS, Watters K, Wilson CWM. The effects of aspirin on the metabolic availability of ascorbic acid in human beings. J Clin Pharmacol 1974;13:480.

5. Sifton DW, ed. Physicians Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1661–2.

6. Sifton DW, ed. Physicians Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1661–2.