Salsalate and Acetazolamide: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 10, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Acetazolamide
Salsalate
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Metabolic acidosis and CNS toxicity (lethargy, confusion, urinary incontinence)
Interaction Deep Dive
The concurrent use of acetaZOLAMIDE and salsalate may result in altered binding and/or altered renal excretion of acetaZOLAMIDE leading to acetaZOLAMIDE toxicity and metabolic acidosis1.
Why it happens (mechanism)
Displacement of acetaZOLAMIDE from plasma protein binding sites and inhibition of renal tubular secretion
Literature reports
1 report — tap to read
a) A case report described a 69-year-old man with a complicated medical history; his drug regimen included salsalate 1500 mg twice daily. Seven days after acetaZOLAMIDE 500 mg twice daily was added to his therapy, the patient became confused, lethargic, incontinent and anorexic. Non-anion-gap hyperchloremic metabolic acidosis secondary to acetaZOLAMIDE toxicity was caused by renal insufficiency and salicylate administration. He was treated with intravenous hydration and discontinuation of both acetaZOLAMIDE and salsalate; over the following seven days, the patient's condition improved. Concurrent use of acetaZOLAMIDE and any salicylate should be avoided 1.
Common questions
Can I take Salsalate and Acetazolamide together?
Metabolic acidosis and CNS toxicity (lethargy, confusion, urinary incontinence) Always confirm with your pharmacist or prescriber before making any change.
How serious is the Salsalate and Acetazolamide interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Salsalate or Acetazolamide need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (1)
- Rousseau P & Fuentevilla-Clifton A: Acetazolamide and salicylate interaction in the elderly: a case report. J Am Geriatr Soc 1993; 41:868-869. PubMed
Keep reading about Acetazolamide
Keep reading about Salsalate
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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