From the Guidelines
It is not safe for a 90-year-old patient on Eliquis (apixaban) 2.5 mg twice daily to use topical methyl salicylate 30% due to the potential increased risk of bleeding. When considering the use of topical methyl salicylate in this patient, several factors must be taken into account, including the potential for systemic absorption and the interaction with anticoagulant therapy. According to the guidelines of care for the management of psoriasis and psoriatic arthritis 1, precautions should be taken when using topical salicylic acid, especially in combination with other oral salicylate drugs, due to the risk of systemic toxicity. Although the study does not directly address the use of topical methyl salicylate with anticoagulants like Eliquis, the principle of caution with salicylate compounds in patients on anticoagulant therapy can be applied. The patient's advanced age and the use of Eliquis increase the risk of bleeding, and adding a salicylate compound like methyl salicylate could potentially enhance this risk. Key considerations include:
- The potential for systemic absorption of topical methyl salicylate, especially when applied to large areas or in patients with abnormal hepatic or renal function 1.
- The theoretical risk of methyl salicylate inhibiting platelet aggregation, which could compound the anticoagulant effects of Eliquis.
- The importance of monitoring for signs of bruising or bleeding if methyl salicylate is used. Given these concerns, alternative pain management options should be considered, such as menthol-based products, lidocaine patches, or acetaminophen, which do not carry the same risk of interaction with anticoagulants. If methyl salicylate must be used, it should be applied sparingly to small areas, avoided on broken skin, and not covered with occlusive dressings, with close monitoring for any adverse effects.
From the Research
Safety of Topical Methyl Salicylate with Apixaban
- The safety of using topical methyl salicylate 30% with apixaban (Eliquis) 2.5 mg twice daily in a 90-year-old patient is not directly addressed in the provided studies.
- However, study 2 investigated the efficacy and safety profile of a topical methyl salicylate and menthol patch in adult patients with mild to moderate muscle strain, and found that the patch was well-tolerated with no serious adverse events reported.
- Study 3 discussed the pharmacologic properties and drug interactions of apixaban, but did not specifically address the interaction between apixaban and topical methyl salicylate.
- Studies 4, 5, and 6 focused on the safety and efficacy of apixaban in various patient populations, but did not provide information on the use of topical methyl salicylate with apixaban.
Potential Interactions
- Although there is no direct evidence on the interaction between apixaban and topical methyl salicylate, it is known that methyl salicylate can increase the risk of bleeding when used with anticoagulants 3.
- However, the studies provided do not investigate the specific combination of apixaban and topical methyl salicylate, and therefore do not provide conclusive evidence on the safety of this combination.
Considerations for Older Adults
- Study 6 found that apixaban concentrations in older adults with atrial fibrillation were higher than expected based on clinical trial data, which may increase the risk of bleeding.
- However, this study did not investigate the use of topical methyl salicylate with apixaban in older adults, and therefore does not provide specific guidance on this combination.