Epidemiology

Over half of all drug-poisoning deaths involve more than one drug, which makes it difficult to ascertain which substance was primarily responsible.[3] The number of deaths related to all drug poisonings increased from 2878 in 2008 to 4907 in 2022.[3]

In the UK, deaths by suicidal overdose of analgesics, including salicylates, were reduced by 22% in the year immediately after the introduction in 1998 of legislation limiting the pack size of analgesics that could be purchased.[4] Non-fatal poisoning with salicylates was also reduced in the second and third year after the legislation was introduced.

Risk factors

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ingestion of ≥125 mg/kg salicylate

In the UK, the National Poisons Information Service recommends that children and adults who might have ingested ≥125 mg/kg or more salicylate, or those who are symptomatic, should be assessed for toxicity.[2]

ingestion of oil of wintergreen (methyl salicylate)

Oil of wintergreen is 98% methyl salicylate, and its ingestion carries a substantial risk of salicylate poisoning.[1][2] Ingestion of any amount of this substance.[1][5]

Found in some topical liniments and non-prescription medications.[1][5]

ingestion of bismuth subsalicylate

Many non-prescription antidiarrheal medications contain bismuth subsalicylate, a 50% aspirin equivalent.[1] Salicylate overdose from these products is rare.

history of self-harm or suicide attempt

Salicylate-containing products may be ingested in overdose as a means of self-harm or suicide attempt.[1][5]

children aged ≤3 years and adults aged ≥70 years

Incorrect salicylate dosing in children and older people can result in toxic salicylate exposure. Accidental ingestion is also of particular concern at extremes of age.[5]

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