Trilisate (Choline magnesium trisalicylate) for pain

Trilisate (Choline magnesium trisalicylate) inhibits the cyclooxygenase enzyme, resulting in the inhibition of prostaglandins. It is used to treat the following conditions:

Mild to moderate pain
Fever
Acute painful conditions like mild arthritis.

Choline magnesium trisalicylate Dose in Adults

For Acute painful conditions:

1.5 g twice daily or 3 g once daily at bedtime

For Mild to moderate pain as an analgesic and antipyretic:

2 to 3 gms daily in 2 or 3 divided doses

Choline magnesium trisalicylate Dose in Childrens

Trilisate for Mild to moderate pain in inflammatory conditions:

Children and Adolescents:
- Patient weight 37 kgs or less: 25 mg/kg/dose twice daily
Fixed-dosing (weight-band):
- 12 to 13 kg: 250 mg twice daily
- 14 to 17 kg: 375 mg twice daily
- 18 to 22 kg: 500 mg twice daily
- 23 to 27 kg: 625 mg twice daily
- 28 to 32 kg: 750 mg twice daily
- 33 to 37 kg: 875 mg twice daily
- more than 37 kgs: Oral: 1,125 mg twice daily
Alternate dosing:
- 10 to 20 mg/kg/dose every twice or thrice daily

Pregnancy Risk Factor C

It has not yet been tested in pregnant women.
It should be avoided during the third trimester of pregnancy due to its effect on the ductus arteriosus.

Trilisate use during breastfeeding:

It can be excreted in breastmilk so it should not be consumed by nursing women.

Choline magnesium trisalicylate Dose in Renal Disease:

The manufacturer has not recommended any dose adjustment in patients with renal disease.
It should be used with caution in patients with mild to moderate renal impairment and avoided in severe renal impairment.

Choline magnesium trisalicylate Dose in Liver Diease:

The mnufacturer has not recommended any dose adjustment.
It should be used with caution in patients with liver disease and drug levels should be monitored.

Common Side Effects of trilisate:

Gastrointestinal:
- Constipation
- Diarrhea
- Dyspepsia
- Epigastric pain
- Heartburn
- Nausea
- Vomiting
Otic:
- Tinnitus

Less Common Side Effects:

Central nervous system:
- Dizziness
- Drowsiness
- Headache
- Lethargy
Otic:
- Auditory impairment

Contraindication to Trilisate include:

Allergy to choline magnesium Trisalicylate, other nonacetylated salticylates, or any component of this formulation

Warnings and Precautions

Gastrointestinal (GI) adverse effects:
- Nausea
- Vomiting
- Gastric upset
- Indigestion
- Heartburn
- Diarrhea
- Constipation
- Sometimes, epigastric pain can be frequent.

Tinnitus
- This could indicate toxic effects. Tinnitus can be caused by a high dose of the drug.

Asthma
- Asthmatic patients should not use it. Asthmatic patients can be sensitive to salicylates and aspirin (Asthma Sensitive Asthma).

Gastrointestinal Disease:
- Gastritis patients and patients with peptic ulcer disease must be cautious about taking the drug.

Hepatic impairment
- Patients with chronic or acute liver disease should be cautious.
Renal impairment
- Patients with chronic or acute kidney disease should be cautious.

Choline magnesium trisalicylate: Drug Interaction

Note: Drug Interaction Categories:

Risk Factor C: Monitor When Using Combination
Risk Factor D: Consider Treatment Modification
Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy).
Antiplatelet Agents (e.g. P2Y12 inhibitors NSAIDs, SSRIs etc.)	Salicylates may have an adverse/toxic effect that can be increased. This could lead to an increase in bleeding risk.
Ajmaline	Salicylates can increase the toxic/adverse effects of Ajmaline. Particularly, there may be an increase in the risk of cholestasis.
Ammonium Chloride	Salicylates may increase serum concentrations
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.
Anticoagulants	Salicylates can increase the anticoagulant effects of Anticoagulants.
Benzbromarone	Salicylates can reduce the therapeutic effects of Benzbromarone.
Blood Glucose-Limiting Agents	Salicylates can increase the hypoglycemic effects of Blood Glucose Lowing Agents.
Corticosteroids (Systemic)	Salicylates can increase the toxic/adverse effect of Systemic Corticosteroids (Systemic). These include bleeding and gastrointestinal ulceration. Systemic corticosteroids may cause a decrease in serum Salicylates. Salicylate toxicities can occur when corticosteroids are stopped.
Loop Diuretics	Loop Diuretics may be affected by Salicylates. The serum concentrations of Salicylates may be increased by Loop Diuretics.
Potassium Phosphate	Salicylates may increase serum concentrations
Probenecid	Probenecid's therapeutic effects may be diminished by salicylates
Salicylates	Other Salicylates may have an enhanced anticoagulant effect.
Thrombolytic Agents	Salicylates can increase the toxic/adverse effects of Thrombolytic agents. There may be an increased risk of bleeding.
Valproate Products	Salicylates can increase serum concentrations of Valproate Products.
Risk Factor D (Take into account therapy modification)
Inhibitors of carbonic anhydrase	Salicylates can increase the toxic/adverse effect of Carbonic Anhydrase Inhibitors. This combination could increase salicylate toxicities. Management: Avoid these combinations when possible.Dichlorphenamide use with high-dose aspirin as contraindicated. Monitor patients carefully for any adverse effects if another combination is used. Tachypnea and anorexia have all been reported. Exceptions: Brinzolamide; Dorzolamide.
Ginkgo Biloba	Salicylates may have an increased anticoagulant activity. Management: You may consider other combinations of these agents. If salicylates are combined with ginkgo biloba, be sure to monitor for bleeding signs and symptoms.
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry)	Salicylates may have an adverse or toxic effect that can be increased. Possible bleeding.
Hyaluronidase	Salicylates can decrease the therapeutic effects of Hyaluronidase. Management: Patients who are given salicylates, especially at higher doses, may not have the desired clinical response to standard doses hyaluronidase. Higher doses of Hyaluronidase might be necessary.
Methotrexate	Methotrexate serum concentrations could be increased by salicylates. Not likely to be of concern are salicylate doses that are used for the prevention of heart attacks.
PRALAtrexate	Salicylates can increase serum PRALAtrexate concentrations. It is unlikely that salicylates used to prophylaxis cardiovascular events will cause concern.
Varicella Virus-Containing Vaccines	Salicylates can increase the toxic/adverse effects of Varicella Virus-Containing Vaccines. Reye's Syndrome could develop.
Vitamin K antagonists (eg warfarin)	Vitamin K Antagonists might have an anticoagulant effect that is enhanced by salicylates.
Risk Factor X (Avoid Combination)
Influenza Virus Vaccine (Live/Attenuated)	Salicylates may have an adverse/toxic effect that can be increased. Reye's syndrome, in particular, may occur.
Sulfinpyrazone	Salicylates can lower the serum concentrations of Sulfinpyrazone.

Monitoring Parameters:

Serum salicylate levels
renal function
hearing changes or tinnitus
abnormal bruising
response to treatment

How to administer Trilisate?

Take the drug orally with food or a large volume of water/ milk to minimize GI upset.
The Liquid may be mixed with juice prior to ingestion.

Mechanism of action of Choline magnesium trisalicylate (trilisate):

It inhibits weakly cyclooxygenase enzymes and results in inhibition of prostaglandin precursors.
It is used as an antipyretic, analgesic, and anti-inflammatory drug.

The absorbtion ofThe liquid formulation of liquids is quick from the stomach or small intestine It is widely available iIt is 95% protein bound and can be found in most tissues and body fluids. It is metabolizedized via cOnjugated to glycine or glucuronide metabolic metabolites. The half-life of the elimination is 9 to 17 hours, and the peak serum concentration is 9 to 17 hours. It is mostly excreted via urine.