Choline Magnesium Trisalicylate

Choline Magnesium Trisalicylate is a combination of choline salicylate and magnesium salicylate. It relieves mild to moderate pain, reduces fever and inflammation or swelling. Choline Magnesium Trisalicylate is effective in the treatment of gout, rheumatic fever, rheumatoid arthritis and muscle injuries.

Choline Magnesium Trisalicylate is primarily indicated in conditions like Osteoarthritis, Pain, Rheumatoid arthritis, Soft tissue rheumatism.

Choline Magnesium Trisalicylate is contraindicated in conditions like Peptic ulcer,Renal failure,Congestive heart failure.

The severe or irreversible adverse effects of Choline Magnesium Trisalicylate, which give rise to further complications include Gastric hemorrhage, Peptic ulceration, Peptic perforation.Choline Magnesium Trisalicylate produces potentially life-threatening effects which include Anaphylactoid reactions, Allergic reactions, Bronchospasm. which are responsible for the discontinuation of Choline Magnesium Trisalicylate therapy.The signs and symptoms that are produced after the acute over dosage of Choline Magnesium Trisalicylate include Vomiting, Coma, Acute renal failure, Confusion, Epigastric pain, Hyperventilation, Irritability, Electrolyte disturbances, Hyper or hypoglycemia, Hyperpyrexia, Oliguria, Light headedness. The symptomatic adverse reactions produced by Choline Magnesium Trisalicylate are more or less tolerable and if they become severe, they can be treated symptomatically, these include Dizziness, Headache, Drowsiness, Tinnitus, Light headedness, Fluid retention.

Concerns related to adverse effects: • 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. Disease-related concerns: • 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. Special populations: • Elderly: Use lowest effective dose for shortest period possible in the elderly; they are a high-risk population for adverse effects from salicylates/NSAIDs. Tinnitus may be a difficult and unreliable indication of toxicity due to age-related hearing loss or eighth cranial nerve damage. • Pediatric: Children and teenagers who have or are recovering from chickenpox, influenza, or flu-like symptoms should not use salicylate products, including choline magnesium trisalicylate. Changes in behavior (along with nausea and vomiting) may be an early sign of Reye's syndrome; patients should be instructed to contact their healthcare provider if these occur.

Concerns related to adverse effects: • 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. Disease-related concerns: • 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. Special populations: • Elderly: Use lowest effective dose for shortest period possible in the elderly; they are a high-risk population for adverse effects from salicylates/NSAIDs. Tinnitus may be a difficult and unreliable indication of toxicity due to age-related hearing loss or eighth cranial nerve damage. • Pediatric: Children and teenagers who have or are recovering from chickenpox, influenza, or flu-like symptoms should not use salicylate products, including choline magnesium trisalicylate. Changes in behavior (along with nausea and vomiting) may be an early sign of Reye's syndrome; patients should be instructed to contact their healthcare provider if these occur.

1.5 mg (1.5 (1.5)) 12 hourly PO — Scraped Dose — Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Liquid, Oral: Generic: 500 mg/5 mL (240 mL)

Should be avoided ( ) —

Should be avoided ( ) —

Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.): May enhance the adverse/toxic effect of Salicylates. Increased risk of bleeding may result. Monitor therapy Agents with Blood Glucose Lowering Effects: Salicylates may enhance the hypoglycemic effect of Agents with Blood Glucose Lowering Effects. Monitor therapy Ajmaline: Salicylates may enhance the adverse/toxic effect of Ajmaline. Specifically, the risk for cholestasis may be increased. Monitor therapy Ammonium Chloride: May increase the serum concentration of Salicylates. Monitor therapy 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. Monitor therapy Anticoagulants: Salicylates may enhance the anticoagulant effect of Anticoagulants. Monitor therapy Benzbromarone: Salicylates may diminish the therapeutic effect of Benzbromarone. Monitor therapy 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. Consider therapy modification 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. Monitor therapy 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. Consider therapy modification Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry): May enhance the adverse/toxic effect of Salicylates. Bleeding may occur. Management: Avoid coadministration of herbs possessing anticoagulant/antiplatelet properties and salicylates. If coadministered, monitor for bleeding. Discontinue anticoagulant/antiplatelet herbs 2 weeks prior to surgical, dental or invasive procedures. Consider therapy modification Hyaluronidase: Salicylates may diminish the therapeutic effect of Hyaluronidase. Monitor therapy Influenza Virus Vaccine (Live/Attenuated): May enhance the adverse/toxic effect of Salicylates. Specifically, Reye's syndrome may develop. Avoid combination Loop Diuretics: Salicylates may diminish the diuretic effect of Loop Diuretics. Loop Diuretics may increase the serum concentration of Salicylates. Monitor therapy 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. Consider therapy modification 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. Consider therapy modification Potassium Phosphate: May increase the serum concentration of Salicylates. Monitor therapy 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. Consider therapy modification Probenecid: Salicylates may diminish the therapeutic effect of Probenecid. Monitor therapy Salicylates: May enhance the anticoagulant effect of other Salicylates. Monitor therapy Sulfinpyrazone: Salicylates may decrease the serum concentration of Sulfinpyrazone. Avoid combination Thrombolytic Agents: Salicylates may enhance the adverse/toxic effect of Thrombolytic Agents. An increased risk of bleeding may occur. Monitor therapy Valproate Products: Salicylates may increase the serum concentration of Valproate Products. Monitor therapy Varicella Virus-Containing Vaccines: Salicylates may enhance the adverse/toxic effect of Varicella Virus-Containing Vaccines. Specifically, the risk for Reye's syndrome may increase. Avoid combination 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. Consider therapy modification

Syrups Store in a well closed container, at room temperature, . Protect from Sunlight, Moisture and Heat.