Question: What Are Salicylates?
What are salicylates? When are salicylates prescribed to treat arthritis? Do salicylates carry the same cardiovascular risk as nonselective NSAIDs and COX-2 selective inhibitors? Are other NSAIDs (e.g. ibuprofen, naproxen, COX-2 inhibitors) more commonly prescribed than salicylates?
Salicylates are drugs that are divided into two groups, acetylated and nonacetylated.
Are Salicylates Associated With Cardiovascular Risk?
Unlike aspirin which inhibits platelet aggregation, thereby increasing the risk of bleeding, nonacetylated compounds have much less of an effect on platelets. As a result, they are less likely to cause bleeding or bleeding ulcers at doses necessary to decrease the inflammation and pain of arthritis.
On the other hand, at least compared to low dose aspirin, there are no studies to support that they are cardioprotective. In fact, like all other NSAIDs (nonsteroidal anti-inflammatory drugs) on the market today, their use may cause an increased risk of serious cardiovascular thrombotic events such as a heart attack.
Whether or not high dose aspirin is as cardioprotective as low dose aspirin has not been studied. In addition, to my knowledge, there are no published studies comparing the efficacy or gastrointestinal safety of the nonacetylated salicylates and the COX-2 inhibitors.
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- FDA Announces Changes for All NSAIDs
- Questions and Answers: FDA Regulatory Actions on COX-2 Inhibitors / NSAIDs
Are NSAIDs and COX-2 Inhibitors More Commonly Prescribed Than Salicylates?
Based on my experience, the nonselective NSAIDs as well as the COX-2 inhibitors are in general, more effective agents to treat the pain and inflammation of arthritis. That being said, a trial of a nonacetylated salicylate is not unreasonable in selected patients with an increased risk of bleeding or ulcers.
Answer provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is author of Arthritis Without Pain - The Miracle Of TNF Blockers. The book is a must-have for anyone on one of the biologic drugs (Enbrel, Remicade, Humira) or considering the biologic drugs. Read my review of the book.