Choline Salicylate

Key facts

• Choline salicylate is a salicylate, the same drug family as aspirin, made into a gel that is applied directly to painful spots inside the mouth.
• It is used for mouth ulcers, denture-related soreness, and other minor irritation of the gums and oral tissue, applied sparingly no more often than the label states, typically no more than three or four times in 24 hours.
• Never give choline salicylate, or any product containing a salicylate, to a child or teenager. Salicylates are linked to Reye syndrome, a rare but life-threatening illness that causes swelling of the liver and brain, particularly during or after a viral illness such as flu or chickenpox.
• Seek urgent care for ringing in the ears, unusual drowsiness, vomiting, or confusion after use, or for mouth pain that lasts more than a week.

What choline salicylate treats

Choline salicylate gel is used in adults for the pain and inflammation of mouth ulcers (aphthous ulcers), sore spots caused by dentures or braces, and other minor irritation of the gums and inner cheek. It is no longer recommended for teething pain in infants or young children; safety concerns, including Reye syndrome, led to this use being withdrawn in many countries.

How choline salicylate works

Salicylates block cyclooxygenase enzymes, lowering local production of prostaglandins, the chemicals that cause pain, swelling and irritation at the site of injury. Applied as a gel, choline salicylate acts mainly on the tissue it touches, though some of the drug is absorbed through the lining of the mouth into the bloodstream.

Before you take it

• Do not use in children or teenagers under 16, especially during or shortly after a viral infection.
• Avoid if you are allergic to aspirin or other NSAIDs, or if you have a history of asthma triggered by aspirin.
• Do not combine with other salicylate or NSAID products, including oral pain relievers, without checking with a pharmacist.
• Tell your prescriber about any bleeding disorder or blood-thinning medicine, and about stomach ulcers.
• Avoid eating or drinking immediately after applying the gel so it has time to work.

Side effects

Common effects are mild local stinging or burning where the gel is applied. True allergic reactions are uncommon.

Seek urgent care for:

• Signs of Reye syndrome after accidental exposure in a child: persistent vomiting, unusual sleepiness, irritability, or confusion.
• Ringing in the ears, hearing changes, rapid breathing, or nausea, which can signal salicylate toxicity.
• Unexplained bruising or bleeding.
• Swelling of the face or throat, or difficulty breathing.

Safety essentials

• The rule on children and teenagers is absolute: no choline salicylate, and no other salicylate or aspirin-containing product, for anyone under 16, especially with a fever or viral illness, because of the risk of Reye syndrome.
• Do not use the gel more often than the label directs. Overuse can cause salicylate toxicity, signaled by ringing ears, nausea and rapid breathing.
• If a child swallows the gel accidentally, seek urgent medical care immediately rather than waiting for symptoms.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.