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Bismuth

Synonyms/Common Names/Related Substances:

  • 214Bi, basic bismuth carbonate (BSC), basic bismuth gallate (BSG), basic bismuth nitrate (BSN), basic bismuth salicylate (BSS), Bi, Bi2O3, biscu, Bismatrol®, Bismatrol® Extra Strength, Bismed®, bismuth aluminate (BA), bismuth ammonium citrate, bismuth biskalcitrate, bismuth carbomer enemas, bismuth gallate, bismuth (III), bismuth oxynitrate, bismuth salts, bismuth subgallate, bismuth subnitrate, bismuth subnitrate suspension (B), bismuth subsalicylate, bismuth sulfate agar (BSA), bismuth tribromophenate (Xeroform®), bismuth-207, bismuth-212, bismuth-213, bismuth-ethylenediamine tetraacetate bisodium (bi-EDTA), bismuthi subcitras colloidal, bismuth-peptide complex (BPC, bicitropeptide), bismuth-phosphate, BSS, calcium acexamate-light bismuth nitrate, colloidal bismuth, colloidal bismuth pectin (CBP), colloidal bismuth subcitrate (CBS), De-Nol®, Gastrin®, Gastrocaps®, GR122311X, Kaopectate®, karaya bismuth, micronized bismuth subnitrate, Pepto-Bismol®, Pepto-Bismol® Easy-to-Swallow Caplets, Pepto-Bismol® Maximum Strength, PMS-bismuth subsalicylate, Q-ULCER®, ranitidine bismuth citrate (Pylorid®, RBC, Rb, Tritec®), Rbc, Roter®, tripotassium dicitrato bismuthate (TBS, TDB, Ventrisol®), tripotassium dicitratobismuthate (De-Nol®), ulcedal, ulcerine, vicalin, wikalina, Xeroform®.
  • Combination product example: Amferol® (kanamycin, bismuth, activated attipulgite).
  • Note: This monograph focuses on bismuth and bismuth subcarbonate, subgallate or subnitrate single-arm studies. Bismuth subsalicylate, colloidal bismuth subcitrate, bismuth aluminate, and ranitidine bismuth products are alluded to, but not expanded on.

Clinical Bottom Line/Effectiveness

Brief Background:

  • Bismuth (Bi) is a chemical element with the atomic number 83. Bismuth-containing compounds include cosmetics (bismuth oxychloride) and pharmaceutical agents. Bismuth is also used in some medical procedures. Although the element bismuth has a history of traditional use dating back to at least the 18th Century, the majority of bismuth-containing products available on the market now are multi-ingredient products and/or are used in combination with other pharmaceutical agents. These multi-ingredient products will not be intensively discussed in this monograph.
  • Examples of bismuth products used in medicine include bismuth subnitrate, bismuth subcarbonate, bismuth subsalicylate (e.g., Pepto-Bismol®, Kaopectate®, bismuth subgallate (e.g., Devrom®), colloidal bismuth subcitrate (e.g., De-Nol®), and ranitidine bismuth subcitrate. According to secondary sources, bismuth subsalicylate, as part of the triple regimen bismuth subsalicylate, metronidazole, and tetracycline hydrochloride, is available as a prescription drug in the United States. According to secondary sources, ranitidine bismuth citrate was withdrawn from the U.S. market in 1998. In general, the bismuth-containing prescription products are mainly used for Helicobacter pylori eradication (1). However, bismuth subsalicylate has also been used for traveler's diarrhea (2).
  • Bismuth compounds to be discussed in this monograph include bismuth subcarbonate, bismuth subgallate, bismuth subnitrate, and bismuth carbomer enemas. Some preliminary evidence suggests that bismuth carbomer enemas may aid in symptoms of pouchitis (3). Bismuth subnitrate has been used for treatment of Helicobacter pylori infection, typically in combination with antibiotics (4), with limited evidence of benefit (1;5). Bismuth subgallate has been studied for ileostomy odor control (6).
  • Plasma and urinary bismuth increases with bismuth use in humans (7). In most cases, increased bismuth levels are not a concern. However, bismuth overdose or use of bismuth in combination with omeprazole may increase blood bismuth beyond desirable levels (8;9). Both acute renal toxicity and encephalopathy due to bismuth toxicity have been discussed in human case studies (8;10).

Dosing/Toxicology

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Precautions/Contraindications

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Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

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Mechanism of Action

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History

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Evidence Table

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Evidence Discussion

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Products Studied

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Author Information

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References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.