Bismuth
- Atc Codes:A07BB#A02BX05#A02BX12
- CAS Codes:14882-18-9#880149-29-1#99-26-3
- PHARMGKB ID:14882-18-9#880149-29-1#99-26-3
Table of contents
- Brand Names
- Drug Combinations
- Chemistry
- Pharmacologic Category
- Mechanism of Action
- Therapeutic Use
- Pregnancy and Lactation Implications
- Contraindications
- Warnings and Precautions
- Adverse Reactions
- Genes that may be involved
- Drug Interactions
- Dosage
- Pharmacokinetics and Pharmacodynamics
- Special Considerations
Brand Names
Europe
Bulgaria: De-Nol, Dermatol; Finland: Orbeseal; France: Granions de Bismuth, Oligosol Bismuth; Germany: Bismutum, Katulcin-R; Hungary: Nilacid; Latvia: De-Nol; Netherlands: Bismuthum; Poland: Bismuthum, Cytribin, De-Nol, Dermatol, Ventrisol; Romania: De-Nol; Spain: Gastrodenol; UK: De-Noltab, Pepto-Bismol.
North America
USA: Bismatrol, Diotame, Kao-Tin, Kapectolin, Maalox Total Stomach Relief, Peptic Relief, Pepto-Bismol.
Latin America
Argentina: Redux; Brazil: Pepto Bismol, Peptulan; Mexico: A-Migdobis, Bisval, Facidmol, Pepto Bismol, Siparox, Sucrato.
Asia
Japan: Bisalumin, Bismuth.
Drug combinations
Bismuth, Fluocinolone, and Lidocaine
Bismuth, Metronidazole, and Tetracycline
Bismuth, Prednisolone, and Zinc Oxide
Chemistry
Bismuth Subsalicylate: C~7~H~5~BiO~4~. Mw: 362.09. (2-Hydroxybenzoato-O^1^)-oxobismuth. CAS-14882-18-9 (1988).
Bismuth Subcitrate Potassium: C~12~H~14~BiK~5~O~17~. Mw: 834.70. 1,2,3-Propanetricarboxylic acid, 2-hydroxy-, bismuth(3+) potassium salt (2:1:5). CAS-880149-29-1 (2007).
Bismuth Subgallate: C~7~H~5~BiO~6~. Mw: 394.09. Gallic acid bismuth basic salt. CAS-99-26-3; CAS-14991-7 (gallic acid)(1988).
Pharmacologic Category
Antacids and Adsorbents. Antidiarrhea Agents. Antiulcer Agents and Acid Suppressants. (ATC-Code: A07BB; A02BX05; A02BX12).
Mechanism of action
Bismuth exhibits both antisecretory and antimicrobial actions. May provide some anti-inflammatory action as well. May protect gastric mucosa, binds to ulcer base and mucosa, binds bile acids, and decreases endogenous prostaglandin and bicarbonate secretion. Reduces number of bowel movements, aids in firming stool, normalizes fluid movement via antisecretory mechanisms, binds bacterial toxins, and exhibits antimicrobial activity in diarrhea. Binds with thiol-containing enzyme in cerebrum. May reduce number of odor-producing anaerobic intestinal microbes and/or directly interact with sulfur-containing compounds.
Therapeutic use
Symptomatic treatment of mild, nonspecific diarrhea (including traveler’s diarrhea). As part of a multidrug regimen for H. pylori eradication. Symptomatic relief of dyspepsia secondary to overindulgence in food and drink. To reduce fecal odors from a colostomy or ileostomy.
Pregnancy and lactiation implications
Not to use in pregnancy (3^rd^ trimester). Excretion in breast milk unknown (salicylates enter breast milk). Use with caution during lactation.
Unlabeled use
Contraindications
Hypersensitivity to bismuth or any component of the formulation. Do not use subsalicylate in influenza or chickenpox (risk of Reye’s syndrome), history of severe gastrointestinal bleeding, history of coagulopathy, or pregnancy (3^rd^ trimester).
Warnings and precautions
Bismuth products may be neurotoxic with very large doses or long-term use. Should be used with caution if taking aspirin, and should not be used if allergic to salicylates, including aspirin. Children and teenagers who have or are recovering from chickenpox or flu-like symptoms should not use subsalicylate (risk of Reye’s syndrome). May increase uric acid, and AST. Absorbs X-rays and may interfere with diagnostic procedures of gastrointestinal tract. Caution in children <3 years of age. May darken stools. May turn tongue black. Do not use in ulcer, bleeding disorder, bloody or black stools, or renal function impairment. Tablets contain aspartame, which is metabolized in the gastrointestinal tract to phenylalanine following oral administration.