Was WIntergreen, now Fwd Post RE: Methyl Salicylate toxicity

[Guest guest]

Hi, Lynda

I'm not a member of that list myself, but you're certainly welcome to

post it there. I figure the more people there are who aware of the

issues, the better. I suppose it's bound to come to people's attention

one way or another, given the huge demographic bulge represented by aging

baby boomers, but there are always better and worse ways to learn a

thing. Anyway, feel free to use it, and thanks for passing it on. I'm

pasting it in below to save you digging up the right message.

regards,

Anne-Marie

_________

Subject: Methyl Salicylate/Salicylates/Salicylism

GENERAL CAUTIONS:

-- A 15 ml bottle of Wintergreen Oil contains more than enough methyl

salicylate to kill a person if ingested OR spilled on the skin. Any

exposure to methyl salicylate, a component of products such as liniments

and solutions used in hot vaporizers, may be lethal to young children.

Less than one teaspoonful of pure methyl salicylate is enough to kill a

young child. It¹s also dangerous to use in combination with many common

over-the-counter medicines including aspirin, Pepto Bismol, and arthritis

medicines and creams, as well as prescription anti-coagulants like

warfarin (Coumadin) which methyl salicylate potentiates, meaning that it

increases their potency.

--People who are allergic to aspirin (ASA or Acetylsalicylic Acid) should

avoid anything containing methyl salicylate. They¹re both salicylates, so

an allergic reaction to one likely means a reaction to the other.

--Never put occlusive coverings, like tensor bandages, on skin that has

had a cream/salve containing Oil of Wintergreen/Methyl Salicylate applied

to it, because it can burn the skin.

SALICYLISM (SALICYLATE TOXICITY):

Nobody disagrees about the symptoms of severe salicylism or how it¹s

caused, but depending on who¹s doing the talking, chemical supply

companies information seems to range from grudging acknowledgment that

chronic low-level absorption through the skin ³might² produce symptoms

of mild salicylism, to those who are fairly unambiguous about it. Some

pharmaceutical companies state quite bluntly that their topical arthritis

medication, for instance, is capable of causing salicylism --worth

noting since the products I looked at had much less methyl salicylate

than most of the OTC products Butch gave us numbers on*. Looking at his

figures on the amount of methyl salicylate in different OTC topical

preparations --remember Icy Hot¹s whopping 29g (that¹s grams, not

milligrams) of methyl salicylate per 100g of product?-- it isn¹t much of

a stretch to imagine how ³harmless² liniment could be the proverbial

straw that breaks the camel¹s back and tips someone over the line if

they¹re taking other salicylate-containing medication.

(*The reference to Butch's numbers concerns information posted by another

listmember on the amount of wintergreen/methyl salicylate in some common

OTC preparations like Ben-Gay, A535, Icy Hot...)

Salicylate poisoning is a more easily produced in elderly patients,

partly because of the reduced liver and kidney function associated with

aging, but also because they¹re often consuming more than one

salicylate-containing medication, apparently without the prescribing

doctor necessarily being aware that salicylates are even present in some.

>From the American Society of Consultant Pharmacists: ³Chronic use of

aspirin or other salicylates is common among elderly persons. Mild

symptoms appear at serum salicylate concentrations of 45-65mg/dL, and

severe toxicity is apparent when levels reach 90mg/dL² then goes on to

list the symptoms (below).

SYMPTOMS OF CHRONIC SALICYLATE TOXICITY:

Mild Salicylism (45-65mg/dL)

---------------

Tinnitus

Dizziness

Headache

Changes in mentation (thinking)

Stomach pain

Severe Salicylism (>90mg/dL)

---------------

Hyperpnea (increased depth of breathing)

Acid-base disorders

Nausea and vomiting

Petechial hemorrhage

Delirium

Hyperthermia

Convulsions

Coma

Unfortuntely, serum levels aren¹t a particularly useful measure for us

regular folk. What we need to know is how much needs to be going in in

the first place to produce those serum levels. We¹re in luck, as it

happens. Several pharmaceutical companies product monographs include the

advisory that as little as 325mg per day of their oral salicylate

medication (which isn¹t an uncommon amount for some cardiac patients¹

prophylatic dose, for example) can cause salicylism. Emergency room

physicians have seen acute cases of salicylate poisoning produced by no

more than that and fatal cases caused by as little as 650mg.

The Consultant Pharmacists agree, warning that ³...chronic salicylate

intoxication can occur even with therapeutic dosages.² Since salicylates

are the most frequently used NON-prescription drug, the scope of the

problem is bigger than we might appreciate right off. From what I¹ve

reading, it seems to be a problem that¹s increasingly coming to the

attention of people working in certain areas: emergency medicine,

pharmacology and especially geriatric medicine. I¹ve run across papers

presented at conferences and symposiums for all these groups in the

course of my reading.

Emergency room physicians and nurses are making a connection between

salicylism and some of the Acute Respiratory Distress episodes they see

in patients with chronic respiratory conditions. I didn¹t get a sense

that the mechanics are understood at this point, but that doesn¹t mean it

isn¹t worth remembering. We didn¹t understand the mechanics of

salicylates at all really until a British researcher figured it out in

1974!

A number of sources make the point that doctors often aren¹t aware of the

OTC preparations their patients are taking, because people assume that

OTC means so safe they don¹t even need to report it when they¹re asked

what other medications they¹re taking. This part¹s anecdotal, but I found

myself remembering how secretive my mother was about medications she was

taking over and above what the doctor prescribed. A few people I¹ve

spoken with about their aging parents and their health have reported the

same behaviour. After puzzling over it for a while, I decided that maybe

being questioned about preparations that are so ³safe² we sell them

without prescription can make us feel as if our basic competence is being

challenged, at a time when we might be feeling increasingly sensitive on

the subject.

SALICYLATE-CONTAINING PRODUCTS:

Acetylsalicylic acid (ASA) is probably the most familiar of the

salicylates, but others include choline salicylate, magnesium salicylate

and sodium salicylate. Aspirin is the most commonly used drug in the U.S.

with as many as 20,000 thousand tons consumed yearly.

Salicylates are used as anti-inflammatory, anti-pyretic (for fever),

analgesic, and anti-thrombotic agents. Aspirin can be found in a number

of over-the-counter preparations including Alka-Seltzer, Ancasal, Astrin,

Cosprin, Easprin, Encaprin, Entrophen, Hiprin, Measurin, Novase, Empirin,

Aspergum, Supasa, Triaphen-10, ZORprin, Ecotrin, Anacin, and Arthritis

pain formula. Some other salicylate-containing drugs are Arthropan,

Tricosal, Trilisate, Doan¹s, Magan, Mobidin, Uracel, Amigesic, Diagen,

Disalcid, Mono-gesia, Arthra-G, Disalcid, Mono-gesic, Salflex, Salgesic,

and Salsitab. Some psoriasis medications and topical preparations used by

chiropodists also contain salicylates.

On a lighter note, there¹s Wint-O-Green Life Savers. For a ittle cheap

amusement, take some with you into a dark room with a mirror. Put a Life

Saver in your mouth and watch in the mirror as you chew it. Don¹t be too

polite; you sort of have to chew with your mouth open (no wonder kids

love this!). You¹ll see blue sparks. It¹s partly light called

triboluminescence, produced by the sugar crystals when they¹re crushed,

caused by the electrons being pushed out of their position in the atomic

field and banging up against nitrogen molecules. The energy of the

collision is transferred to the nitrogen molecules and they vibrate,

emitting light (a little visible light, but mostly UV) as their way of

discharging the excess energy. It¹s the methyl salicylate that really

causes the light show, though, because it¹s fluorescent, absorbing the

short-wavelength UV light from the excited nitrogen and re-emitting it as

longer-wavelength visible light: the blue sparks.

**************

SOURCES:

in part, and in no particular order,

NIH Medline

Canadian Journal of Emergency Medicine

The Merck Manual

American Society of Consultant Pharmacists

BC Healthguide

Internal Medicine Archives, American Medical Association

Various universities¹ medical faculty and chemistry faculty webpages

Several pharmaceutical companies¹ websites

Several chemical supply houses, including Fisher Scientific & Sigma

Chemical, for MSDS info:

--Sigma:

--Fisher Scientific:

E amst-laurent@...

W http://holecomm.ca/~redwing/

--

Lynda Sorenson

http://www.Luna-Aromatics.com