Salicylate Toxicity: What to Know About This Potential OTC Medication Overdose

We often think nothing of taking over-the-counter (OTC) medications. They're viewed as safe or risk-free options for treating mild symptoms. And, if taken as directed, OTC products are usually well tolerated.

But, it's also true that OTC products can contain substances that can be harmful. They can cause side effects, interact with other medications, or even cause dangerous toxicity in high amounts.

One such example is salicylates (or salicylic acid), an ingredient in aspirin. Too much salicylate can lead to a potentially life-threatening complication called salicylate toxicity. And combining several salicylate-containing medications can raise the risk of this.

But how much salicylate is too much?

What causes salicylate toxicity? 

Salicylate toxicity or poisoning occurs when people take too much of a medication containing salicylates. It can happen suddenly if someone takes a single, high dose of one of these medications. But it can also happen gradually over time. In that case, someone would take repeated high doses over a longer period of time (several days or weeks).

Salicylate toxicity causes severe chemical imbalances inside the body. Symptoms can range from mild to life-threatening (more on that below). Salicylate toxicity is a medical emergency and requires immediate care.

What is salicylate?

Salicylates are commonly found in many OTC and prescription medications. Medications containing salicylate are typically taken by mouth or applied to the skin. But some salicylates come in other forms, such as rectal suppositories.

Examples of some salicylate medications include:

• Alka-Seltzer Extra Strength (aspirin/citric acid/sodium bicarbonate)

• Aspercreme (trolamine salicylate)

• Aspirin

• Choline magnesium trisalicylate

• Diflunisal

• Doan’s Extra Strength (magnesium salicylate)

• Mesalamine (Asacol HD, Canasa, Rowasa)

• Methyl salicylate

• Pepto-Bismol (bismuth subsalicylate)

• Salicylic acid

• Salonpas pain relieving patches (camphor/menthol/methyl salicylate)

• Salsalate

What are the symptoms of salicylate toxicity?

A high level of salicylate in the body can affect multiple different parts of the body. As mentioned above, there are both mild and severe symptoms of salicylate toxicity. But any symptoms associated with toxicity can indicate a serious condition.

Symptoms of salicylate toxicity include:

• Headache or dizziness

• Lethargy, confusion, or hallucinations

• Ringing in the ears (tinnitus)

• Rapid breathing or shortness of breath

• Rapid heart rate or palpitations

• Nausea and vomiting

• Abdominal pain

• Dizziness or loss of balance when changing positions (orthostatic hypotension)

Dangerously high levels of salicylate are life-threatening. This can lead to the following complications:

• Fluid buildup in the brain or lungs

• Seizures

• Respiratory failure

• Abnormal heart rhythms (arrhythmias)

• Cardiac arrest

If you believe you’re experiencing symptoms of salicylate toxicity, call 911 or go to the nearest emergency room.

How does salicylate toxicity affect the body?

Salicylates affect multiple different systems and processes in the body. But one of the main ways it poisons the body is by changing the acid-base balance of the blood. More specifically, it leads to a buildup of acid in the blood. And this is what causes many of the symptoms above.

Salicylates also directly stimulate brain function. More specifically, it stimulates the part of the brain that controls breathing. This is why someone with salicylate toxicity starts to breathe faster. It also stimulates a part of the brain that controls nausea and vomiting, which is why it's also a common symptom.

Finally, salicylate toxicity causes fluid to build up in the brain and lungs. Experts aren’t exactly sure why this happens, but it happens in the later stages of toxicity. This is what causes respiratory failure and seizures.

How serious is salicylate toxicity?

Salicylate toxicity is very serious and requires immediate medical attention. Call 911 if you or a loved one may be experiencing salicylate toxicity. Poison Control also offers free, expert help 24 hours a day online or by calling 1-800-222-1222.

It’s important to let healthcare providers know how much salicylates you took and when. This will help healthcare providers treat the salicylate toxicity and prevent further complications.

How do you treat salicylate toxicity?

There’s no antidote or reversal for salicylate toxicity. But there are many different treatments that can help prevent or treat complications. These treatments cannot be done at home. That’s why it’s important to seek emergency medical care for salicylate toxicity.

Treatment for salicylate toxicity can include:

• Close monitoring of the amount salicylate and acid in the blood

• Intravenous (IV) fluids to help rehydrate the body

• Medications that help get rid of the excess acid in the blood

• Correction of electrolyte and blood sugar levels

• Ensuring adequate breathing — this may sometimes require intubation (a tube placed in the throat to help a person breathe)

In severe cases, someone may even need emergency hemodialysis. This can rapidly remove the salicylate from the blood, and normalize the acid-base balance. 

What are some alternatives to aspirin and other salicylate medications?

Taking aspirin and salicylate medications at recommended doses is generally safe. It’s typically only dangerous if people take high amounts of medication. But there are alternatives to aspirin and other salicylate medications. 

Acetaminophen (Tylenol) can be used OTC to treat mild to moderate pain and fever. Other OTC pain medications include ibuprofen (Advil, Motrin) and naproxen (Aleve). Benzoyl peroxide can be used instead of salicylic acid to treat acne. Lidocaine patches and Voltaren gel (diclofenac) are two OTC topical options that can be used instead of Aspercreme or Salonpas.

Prescription salicylates are typically used to treat chronic health conditions. It’s important to discuss alternatives with your healthcare provider before stopping your current medications. Be sure to ask your provider and pharmacist when selecting OTC medications if you use prescription salicylates. They can help you select OTC medications that aren’t in the salicylate family.

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Written by:

Kevin Le, PharmD, BCPS, BCPPS

Kevin Le, PharmD, BCPS, BCPPS is a clinical pharmacy specialist in solid organ transplant at Ann & Robert H. Lurie Children’s Hospital of Chicago. He has been working as a pediatric pharmacist since 2016.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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