A topical analgesic and anti-inflammatory combination used for the relief of mild to moderate pain and inflammation associated with musculoskeletal conditions. Choline salicylate is a non-steroidal anti-inflammatory drug (NSAID) that provides anti-inflammatory and analgesic effects, while lidocaine is a local anesthetic that provides rapid pain relief by blocking nerve conduction.
Adult: Apply a thin layer (2-4 g, approx. 1-2 inches of gel) to the affected area 3 to 4 times daily. Gently rub in. Do not apply more than 4 times in 24 hours.
Note: For external use only. Wash hands before and after application. Apply to clean, dry, intact skin. Do not cover with occlusive dressings unless advised by a doctor. Do not apply near eyes, mouth, genital areas, or on mucous membranes. Do not use with heating pads.
The combination works via two distinct mechanisms. Lidocaine blocks voltage-gated sodium channels on neuronal membranes, inhibiting the initiation and conduction of nerve impulses, leading to localized numbness. Choline salicylate, after conversion to salicylic acid, inhibits the cyclooxygenase (COX) enzymes, particularly COX-1 and COX-2, thereby reducing the synthesis of prostaglandins, which are mediators of pain, inflammation, and fever.
Pregnancy: Category C (US FDA). Avoid in first and second trimesters unless clearly needed. CONTRAINDICATED in third trimester due to risk of premature closure of ductus arteriosus, delayed labor, and maternal/neonatal bleeding.
Driving: May cause dizziness or localized numbness. Patients should not drive or operate machinery until they know how the medication affects them, especially if applied to hands.
| Anticoagulants (Warfarin, Acenocoumarol) | Increased risk of bleeding due to antiplatelet effect of salicylate. | Major |
| Other Oral NSAIDs (Ibuprofen, Diclofenac) | Increased risk of GI toxicity and renal impairment. May diminish cardioprotective effect of aspirin. | Major |
| Methotrexate | Salicylate may decrease renal clearance of methotrexate, increasing toxicity risk. | Major |
| Lithium | Salicylate may decrease renal clearance of lithium, leading to toxicity. | Major |
| ACE Inhibitors (Enalapril, Ramipril) | Salicylate may reduce antihypertensive efficacy. | Moderate |
| Diuretics (Furosemide) | Risk of reduced diuretic and antihypertensive effect; potential for nephrotoxicity. | Moderate |
| Antiepileptics (Phenytoin, Carbamazepine) | Lidocaine toxicity risk may increase due to CYP competition. | Moderate |
| Beta-blockers (Propranolol) | May increase risk of lidocaine toxicity by reducing hepatic blood flow. | Moderate |
Same composition (Choline Salicylate (9% w/w) + Lidocaine (2% w/w)), different brands: