A topical oral solution combining a non-steroidal anti-inflammatory drug (NSAID) derivative, choline salicylate, with an astringent and protein precipitant, tannic acid. It is primarily indicated for the symptomatic relief of pain and inflammation associated with minor mouth and throat conditions. Choline salicylate provides analgesic and anti-inflammatory action, while tannic acid acts as an astringent to tighten tissues, reduce inflammation, and provide a protective coating over irritated mucous membranes.
Adult: Gargle or rinse with 10-15 mL (approximately 2-3 teaspoonfuls) of the undiluted solution for 1-2 minutes, then spit out. Do not swallow. Use every 3-4 hours as needed, not to exceed 8 times in 24 hours.
Note: 1. Shake the bottle well before use. 2. Measure the recommended quantity using the cap or a measuring cup. 3. Gargle or rinse thoroughly, ensuring contact with all affected areas for 1-2 minutes. 4. SPIT OUT COMPLETELY. DO NOT SWALLOW. 5. Avoid eating or drinking for at least 15-20 minutes after application to allow the medicine to work. 6. Do not use for more than 7 days unless directed by a physician.
Choline Salicylate: Upon topical application, it is hydrolyzed to release salicylic acid. Salicylates inhibit the cyclooxygenase (COX) enzymes, COX-1 and COX-2, thereby reducing the synthesis of prostaglandins (PGs) and thromboxanes from arachidonic acid. This inhibition decreases the sensitization of pain receptors (nociceptors) to mechanical and chemical stimuli and reduces inflammatory mediators at the site of application, providing local analgesic and anti-inflammatory effects. Tannic Acid: Acts as an astringent by precipitating proteins on the surface of the inflamed or ulcerated oral mucosa. This forms a protective layer or coat, which reduces permeability, shrinks and constricts tissues, decreases local exudation, and provides a soothing effect. It also has mild antibacterial properties.
Pregnancy: Category D (as per salicylates). Avoid, especially in the third trimester due to risk of premature closure of ductus arteriosus, prolonged labor, and increased maternal and neonatal bleeding risk. Use in first and second trimester only if potential benefit justifies potential fetal risk. Topical use with minimal systemic absorption is preferred over oral NSAIDs, but caution remains.
Driving: Unlikely to affect driving ability when used topically as directed. However, if systemic absorption occurs (e.g., from swallowing), dizziness or tinnitus may impair alertness.
| Anticoagulants (Warfarin, Acenocoumarol) | Increased risk of bleeding due to additive antiplatelet effect and potential displacement from protein binding sites. | Major - Contraindicated |
| Other NSAIDs (Ibuprofen, Diclofenac) | Increased risk of GI side effects and bleeding. No additional therapeutic benefit. | Major |
| Methotrexate | Salicylates can decrease renal clearance of methotrexate, increasing its toxicity (myelosuppression). | Major |
| Sulfonylureas (Glibenclamide, Glimepiride) | Salicylates may potentiate hypoglycemic effect. | Moderate |
| Valproic Acid | Salicylates can displace valproic acid from protein binding, increasing free drug levels and risk of toxicity. | Moderate |
| Corticosteroids (e.g., Prednisolone) | Increased risk of GI ulceration. Steroids may reduce salicylate levels. | Moderate |
| ACE Inhibitors (e.g., Enalapril) | Salicylates may diminish the antihypertensive effect. | Moderate |
| Diuretics | Salicylates may reduce the efficacy of loop diuretics (furosemide) and thiazides. Risk of dehydration and renal impairment. | Moderate |
| Probenecid | Salicylates antagonize the uricosuric effect of probenecid. | Moderate |