Salicylate

Salicylate topical preparations are an alternative for osteoarthritis (OA) pain not relieved with acetaminophen or for people who cannot tolerate or are reluctant to use oral medications. Topical salicylate may work by decreasing pain and inflammation; however, there is limited evidence to support the use of topical salicylate as an effective treatment for OA pain.

Topical salicylates may be used in addition to DMARDs or biologics to treat the pain of inflammatory arthritis; however, these products are not routinely used in the treatment of inflammatory arthritis.

Salicylate is available in topical preparations that may be applied directly to the skin over a joint to help lessen the pain of OA.

Apply sparingly three or four times daily and massage into the affected area. 

Salicylate compounds block enzymes called cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). These enzymes are responsible for converting arachidonic acid into prostaglandin, which plays a role in inflammation. By blocking COX-1 and COX-2, topical salicylates reduce joint pain and inflammation where they are applied. 

Salicylates do not provide immediate relief to pain; pain relief may take several weeks with daily administration.

Do not use topical salicylate preparations if you are allergic to salicylates (acetylsalicylic acid-based medications, such as Aspirin®), or if you are taking anticoagulant medications (e.g., warfarin). When administered with anticoagulant medications, a possible additive effect on blood thinning may occur and may increase the risk of bleeding.

For people taking oral non-steroidal anti-inflammatory drugs (NSAIDs) regularly, please speak with your healthcare provider before using topical salicylates.

Salicylate products are for external use only. If rash or irritation occurs, discontinue use. If condition worsens or symptoms persist, discontinue use and contact your healthcare provider.

Avoid contact with eyes. After application, wash hands thoroughly to prevent spreading the product to eyes and mouth. Flush with water if contact does occur.

Don’t bandage the areas where salicylate has been applied and avoid other sources of heat such as heating pads.

Never apply to wounds or damaged skin.

Skin irritation, local burning, stinging and/or redness are common.

Overuse of salicylate creams can lead to increased absorption into the bloodstream. This can increase the risk of adverse effects, such as bleeding from salicylate toxicity.

Apply topical salicylate products as recommended and contact your healthcare provider if you have any concerns while using the medication.

On occasion, you may need blood work while using topical salicylates. Your healthcare provider may meet with you regularly to ensure that your pain is adequately controlled.

Store this medication at room temperature (15 to 30 degrees Celsius), away from direct sunlight and keep it out of reach of children.