salsalate
Salsalate is a medication used to treat pain and swelling from arthritis. It comes as a tablet that's taken by mouth, typically 2 to 3 times a day. Side effects of salsalate include nausea, dizziness, and temporary hearing problems. This medication used to be sold as the brand name Disalcid, but is now only available as a generic version.
What is Salsalate?
What is Salsalate used for?
Pain and swelling from osteoarthritis (OA) or rheumatoid arthritis (RA) in adults
How Salsalate works
Salsalate is a non-steroidal anti-inflammatory drug (NSAID). It works by blocking proteins in your body (called cyclooxygenase or COX) that cause inflammation, pain, and swelling.
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What are the side effects of Salsalate?
Common Side Effects
- Ringing in the ears
- Temporary hearing problems
- Nausea
- Vertigo (dizziness)
- Rash
Other Side Effects
- Stomach pain
- Diarrhea
- Stomach bleeding
- Hives
Serious Side Effects
- Stomach bleeding: feeling faint, vomiting blood, bloody or dark stools, severe stomach pain or discomfort
- Heart attack: chest pain or tightness, pain that radiates up to your shoulder, arm, neck, or jaw
- Stroke: chest pain, trouble breathing, weakness in one part of your body or face, slurred speech
- Heart failure: difficulty breathing, swelling, fast heartbeat
- Liver problems: swelling of your stomach, yellowing of your skin or the whites of your eyes, confusion, dark or brown urine
- Kidney problems: tiredness, dry and itchy skin, low appetite, urinating less than usual, foamy or bloody urine, muscle cramps
- Allergic reactions: hives, rash, blisters, swelling of the lips or tongue, difficulty breathing
- Serious skin reactions: skin reddening, blisters, rash, fever
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds, red or dark brown urine, small red or purple spots on skin, unusual bruising or bleeding
- Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
- Heart failure—shortness of breath, swelling of the ankles, feet, or hands, sudden weight gain, unusual weakness or fatigue
- Increase in blood pressure
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Rash, fever, and swollen lymph nodes
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
- Round red or dark patches on the skin that may itch, burn, and blister
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Headache
- Loss of appetite
- Nausea
- Upset stomach
Pros and cons of Salsalate
Pros
Works well for treating pain and inflammation
Can take with acetaminophen (Tylenol) for extra pain control, if your provider says it's ok to do so
Available as a lower-cost generic medication
Cons
Only available as a tablet
Can take about 3 to 4 days to feel the full effects
Not safe to take after 20 weeks of pregnancy
Pharmacist tips for Salsalate
You can take salsalate with or without food. But it's best to take it with food or milk to prevent getting an upset stomach as a side effect of the medication.
Don't drink alcohol while taking salsalate because it can raise your risk for stomach bleeds and stomach ulcers.
Salsalate can potentially cause changes in your hearing, including ringing in the ears and hearing loss. Your provider might test your hearing throughout treatment. Seek medical help right away if you notice changes in your hearing.
It can take 3 to 4 days after starting salsalate to feel its full effects. Don't get discouraged if you don't experience quick pain relief after the first few doses. If you have concerns about how well salsalate is working for you, talk to your provider.
If you're allergic to aspirin, there's a chance you might be allergic to salsalate as well. Tell your provider about all your allergies.
Salsalate can interact with a lot of other common medications, such as blood pressure medications and blood thinners (including aspirin). Make sure to tell your provider about all of the medications you're taking or planning to take before starting salsalate. They can make sure your medications are safe for you to take together.
Don't take salsalate with other NSAIDs, such as ibuprofen (Motrin, Advil). Doing so puts you at higher risk for stomach bleeds. NSAIDs are commonly found in many over-the-counter pain and cold medications. Talk with your healthcare provider or pharmacist if you're not sure whether you're already taking an NSAID.
Tell your provider if you have flu symptoms. It's not recommended to take salsalate if you have the flu or chicken pox because of the risk of Reye's syndrome.
If you're pregnant or thinking of becoming pregnant, speak with your provider before using salsalate. You'll need to avoid taking salsalate during the second half of pregnancy (week 20 of pregnancy or later) because it might cause harm to your unborn baby or complications during delivery.
Frequently asked questions about Salsalate
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What are the risks and warnings for Salsalate?
Salsalate can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Heart attack and stroke
Risk factors: History of heart problems, including heart attack | Taking high doses of salsalate | Taking salsalate for a long time | History of heart bypass surgery
Salsalate can raise your risk of having blood clots, heart attacks, or strokes. People with heart problems, those taking high doses of salsalate, and those taking salsalate for a long time have a higher risk of this happening. That’s why it’s important to take the lowest possible dose for the shortest possible time. If you have heart problems, talk to your healthcare provider before starting this medication. Don't take salsalate if you've had or will be having heart bypass surgery. Call 911 or seek immediate medical help if you experience chest pain, trouble breathing, weakness on one side of your body, or trouble speaking or walking.
Stomach bleeding and ulcers
Risk factors: History of stomach bleeding or ulcers | Older adults | Taking aspirin, other NSAIDs, corticosteroids, blood thinners, or SSRIs | Drinking alcohol | Smoking | Having poor health | Bleeding problems | Liver problems | Taking salsalate for a long time | Taking high doses of salsalate
Salsalate can cause stomach bleeding and ulcers, which can be dangerous. There are many conditions and medications that raise your risk of this problem, so speak with your provider before starting this medication. Stomach bleeding and ulcers can occur without warning or symptoms, so it's best to take the lowest possible dose for the shortest possible time to minimize your risk. If you notice blood in your vomit, stool that looks like black coffee grounds, or if you have pain in your stomach that doesn't go away, stop taking salsalate and talk to your healthcare provider right away.
High blood pressure and heart failure
Risk factors: Heart problems
Salsalate can cause your body to hold onto extra fluid, which can raise your blood pressure or put you at risk for heart failure. Tell your provider if you have a history of heart problems or are taking blood pressure medications before starting salsalate to make sure it's safe for you. Your provider will check for heart problems before they prescribe this medication to you. If you experience unexplained fainting, chest pain with physical activity, or irregular heartbeat while taking salsalate, contact your provider.
Kidney damage and high potassium levels
Risk factors: Kidney or liver problems | Heart failure | Taking other medications that can harm the kidneys | Older adults | Loss of body fluid through conditions such as severe vomiting, bleeding, or diarrhea | Using salsalate for a long time
Salsalate can damage your kidneys by slowing down blood flow to the kidneys. The risk is higher if you're taking other medications that can harm the kidneys, or have certain conditions (like kidney, liver, or heart problems). Kidney damage is usually reversible once you stop taking salsalate. This medication isn't recommended if you have very severe kidney problems, so discuss the risks and benefits of taking it with your provider. Let your provider know if you notice a change in how often you urinate after starting salsalate as this can be a sign of kidney damage.
Liver damage
Risk factors: History of liver problems | Taking other medications that can cause liver damage | Taking high doses of salsalate | Drinking alcohol | Taking salsalate for a long time
Although rare, salsalate can cause life-threatening liver damage. Your risk is higher if you take salsalate with other medications that can also cause liver damage, such as acetaminophen (Tylenol). Liver damage can happen with or without symptoms, so if you take this medication for a long time, you might need to get lab work done regularly to check your liver. Stop salsalate and talk to your healthcare provider right away if you experience symptoms, such as fever, chills, fatigue, nausea, vomiting, yellowing of the skin or whites of the eyes, clay-colored stool, and dark urine.
Severe allergic and skin reactions
Risk factors: Aspirin allergy | NSAID allergy
Severe allergic reactions to salsalate are possible, including life-threatening reactions like facial swelling, shock, and anaphylaxis. Let your provider know if you have an allergy to aspirin or other NSAIDs before starting salsalate. If you notice hives, rash, red skin, swelling of the lips or tongue, or difficulty breathing after using salsalate, call for medical help as soon as possible.
Although rare, salsalate can cause serious skin reactions, such as rash, blisters, skin reddening, or skin peeling. If you notice changes in your skin, stop using salsalate and get medical attention right away.
Not for use in pregnant or breastfeeding females
If you're pregnant or breastfeeding, talk to your provider first about the risk and benefits of salsalate before using this medication. Salsalate can cause harm to your unborn baby or complications during delivery if taken during the second half of pregnancy.
Salsalate dosage forms
Typical dosing for Salsalate
Adults: The typical dose is 3,000 mg per day total, split up into 2 to 3 smaller doses and taken by mouth throughout the day.
Your provider will adjust the dose based on how well you're responding to the medication, your age, and if you're having side effects.
How much does Salsalate cost?
Salsalate contraindications
History of asthma, hives, or other allergic reactions after taking aspirin or another NSAID
Use of salsalate after coronary artery bypass graft surgery (CABG)
What are alternatives to Salsalate?
Pain and swelling from osteoarthritis (OA) or rheumatoid arthritis (RA) in adults
Pain from osteoarthritis
Pain from rheumatoid arthritis
Salsalate images
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References
Best studies we foundAmerican Heart Association. (2020). What are anticoagulants and antiplatelet agents?
Amneal Pharmaceuticals LLC. (2023). Salsalate tablet [package insert]. DailyMed.
Department of Justice/Drug Enforcement Administration. (2020). Narcotics.
Miller, L. G., et al. (1969). Selecting nonsteroidal anti-inflammatory drugs: Pharmacologic and clinical considerations. Journal of the American Board of Family Medicine.
National Heart, Lung, and Blood Institute. (2022). What is coronary artery bypass grafting?
Trifilio, S., et al. (2021). The non-steroidal anti-inflammatory drug salsalate provides safe and effective control of mucositis-unrelated pain during autologous and allogeneic hematopoietic stem cell transplantation. Supportive Care in Cancer.
U.S. Food and Drug Administration. (2020). Nonsteroidal anti-inflammatory drugs (NSAIDs): Drug Safety Communication - Avoid use of NSAIDs in pregnancy at 20 weeks or later.
U.S. Food and Drug Administration. (2023). FDA recommends avoiding use of NSAIDs in pregnancy at 20 weeks or later because they can result in low amniotic fluid.
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