Bismuth
Bismuth/Drug Interactions:
GeneralGeneral: Most interactions attributed to bismuth-containing products are due to other ingredients in the product, such as salicylate or ranitidine. For example, the salicylate component may have potential interactions with other anticoagulants, antidiabetic agents, hypouricemic agents, and other salicylates. Colloidal bismuth subcitrate may reduce aspirin-induced gastric microbleeding (121). Tripotassium dicitratobismuthate may aid in nonsteroidal anti-inflammatory-induced ulcers (122). AntacidsAntacids: In humans, bismuth subnitrate increased the percentage of time that gastric pH was above 3 and the time after a standard meal that the pH was above 3 (123). AntibioticsAntibiotics: According to a review, colloidal bismuth subcitrate, bismuth subsalicylate, and ranitidine bismuth citrate exerted synergistic effects in suppressing Helicobacter pylori (124). Bismuth, a trivalent cation, may form insoluble complexes with tetracycline and quinolone antibiotics, thereby reducing the bioavailability of the antibiotic (44; 45; 46). Experts recommend staggering the administrations times. However, some evidence suggests that bismuth is unlikely responsible (125). In one study, bismuth subsalicylate had no effect on pharmacokinetics of ciprofloxacin in healthy volunteers (126). Notably, antibiotics and bismuth are used in combination as part of a multitherapy regimen for various gastric and duodenal disorders (127; 25; 97; 128; 129; 130; 131). Anticoagulants and antiplateletsAnticoagulants and antiplatelets: The combination of bismuth salicylate and anticoagulants is not suggested, due to the salicylate component of the medication, which may displace warfarin and increase the risk of bleeding, according to secondary sources. Bismuth is unlikely to be responsible. In humans, bismuth subgallate activated factor XII and accelerated the coagulation cascade (15). AntidiabeticsAntidiabetics: According to secondary sources, concurrent use of antidiabetic agents and bismuth subsalicylate may potentiate the antidiabetic effects and increase the risk of hypoglycemia.Antigout agentsAntigout agents: According to secondary sources, bismuth subsalicylate may suppress the uricosuric action of sulfinpyrazone and probenecid.AntineoplasticsAntineoplastics: In humans, addition of bismuth subnitrate, ginseng, and tang-kuei ten to cisplatin administration reduced beta-2-microglobulin and NAG in the urine, consistent with reduced renal impairment (132). MetronidazoleMetronidazole: Resistance to metronidazole is decreased by the addition of bismuth in humans (133).OmeprazoleOmeprazole: In humans, omeprazole reduced bismuth (as bismuth biskalcitrate) bioavailability when bismuth was given in a capsule also containing metronidazole and tetracycline (61). In a separate study in humans, omeprazole increased absorption of bismuth, as tripotassium dicitratobismuthate (134). The systemic availability of bismuth was also increased by the coadministration of omeprazole and bismuth (tripotassium dicitratobismuthate) in a second study by Trieber et al. (135). In this study, omeprazole decreased the Helicobacter pylori-eradicating potential of bismuth. The addition of omeprazole to colloidal bismuth subcitrate, omeprazole, and amoxicillin, for Helicobacter pylori eradication, resulted in increased plasma bismuth levels in humans (9). Three of 34 patients taking this combination of medications had plasma bismuth concentrations within the Hillemand "alarm" level (54.2, 64.7, and 91.8mcg/L). Opiate agonistsOpiate agonists: According to secondary sources, concurrent use of bismuth subsalicylate and opiate agonists may increase the risk of constipation.PhenytoinPhenytoin: According to secondary sources, bismuth subsalicylate may decrease the absorption of phenytoin.SalicylatesSalicylates: Theoretically, the use of bismuth salicylate in combination with other salicylates may increase salicylate-induced adverse effects.Bismuth/Herb/Supplement Interactions:
GeneralGeneral: Most interactions attributed to bismuth-containing products are due to other ingredients in the product, such as salicylate or ranitidine. For example, the salicylate component may have potential interactions with other anticoagulants, antidiabetic agents, hypouricemic agents, and other salicylates. Colloidal bismuth subcitrate may reduce aspirin-induced gastric microbleeding (121). Tripotassium dicitratobismuthate may aid in nonsteroidal anti-inflammatory-induced ulcers (122). AntibacterialsAntibacterials: According to a review, colloidal bismuth subcitrate, bismuth subsalicylate, and ranitidine bismuth citrate exerted synergistic effects in suppressing Helicobacter pylori (124). Bismuth, a trivalent cation, may form insoluble complexes with tetracycline and quinolone antibiotics, thereby reducing the bioavailability of the antibiotic agents (44; 45; 46). Experts recommend staggering the administrations times. However, some evidence suggests that bismuth is unlikely responsible (125). In one study, bismuth subsalicylate had no effect on pharmacokinetics of ciprofloxacin in healthy volunteers (126). Notably, antibiotics and bismuth are used in combination as part of a multitherapy regimen for various gastric and duodenal disorders (127; 25; 97; 128; 129; 130; 131). Anticoagulants and antiplateletsAnticoagulants and antiplatelets: The combination of bismuth salicylate and anticoagulants is not suggested, due to the salicylate component of the medication, which may increase the risk of bleeding, according to secondary sources. Bismuth is unlikely to be responsible. In humans, bismuth subgallate activated factor XII and accelerated the coagulation cascade (15). AntineoplasticsAntineoplastics: In humans, addition of bismuth subnitrate, ginseng, and tang-kuei ten to cisplatin administration reduced beta-2-microglobulin and NAG in the urine, consistent with reduced renal impairment (132). AntioxidantsAntioxidants: In humans, supplementation with antioxidants (Oxy-Gard) reduced ornithine decarboxylase activity in the antral gastric mucosa of patients with atrophic gastritis accompanied by intestinal metaplasia (136). HypoglycemicsHypoglycemics: According to secondary sources, concurrent use of antidiabetic agents and bismuth subsalicylate may potentiate antidiabetic effects and increase the risk of hypoglycemia.SalicylatesSalicylates: Theoretically, the use of bismuth salicylate in combination with other salicylates may increase salicylate-induced adverse effects.SarsaparillaSarsaparilla: Secondary sources suggest sarsaparilla may increase the absorption of bismuth from products such as Pepto-Bismol?.Vitamin CVitamin C: In a review, it was suggested that vitamin C decreases Helicobacter pylori in humans and animals (4). Therefore, in theory, use of bismuth may have additive effects. Bismuth/Food Interactions:
Insufficient available evidence.Bismuth/Lab Interactions:
GeneralGeneral: Most interactions attributed to bismuth-containing products are due to other ingredients in the product, such as salicylate or ranitidine. For example, the salicylate component may have potential interactions with other anticoagulants, antidiabetic agents, hypouricemic agents, and other salicylates. Colloidal bismuth subcitrate may reduce aspirin-induced gastric microbleeding (121). Tripotassium dicitratobismuthate may aid in nonsteroidal anti-inflammatory-induced ulcers (122). Bismuth (plasma and urinary)Bismuth (plasma and urinary): Plasma and urinary bismuth increase with bismuth use in humans (7). Serum bismuth levels of 495mcg/L were documented in a 16 year-old girl with acute renal failure following an overdose with colloidal bismuth subcitrate (8). Blood urea nitrogenBlood urea nitrogen: Blood urea nitrogen levels of 102mg/dL were documented in a 16 year-old girl with acute renal failure following an overdose with colloidal bismuth subcitrate (8). CreatinineCreatinine: Serum creatinine levels of 19.9mg/dL were documented in a 16 year-old girl with acute renal failure following an overdose with colloidal bismuth subcitrate (8). MagnesiumMagnesium: Use of bismuth subnitrate medications caused a slight increase in blood magnesium in a clinical trial (137). Prostaglandin E2Prostaglandin E2: The effect of colloidal bismuth subcitrate on gastric and duodenal levels of prostaglandin E2 has been examined (138). In humans, bismuth subnitrate increased mucosal PGE2 synthesis (123). Serum gastrinSerum gastrin: Serum gastrin decreased in humans after successful Helicobacter pylori eradication with bismuth-containing agents (139). Ranitidine bismuth citrate did not counteract the rise of ranitidine-induced gastrin following a meal (140). Serum IgGSerum IgG: Serum IgE level decreased after treatment of patients with dyspepsia with colloidal bismuth subcitrate (131). Serum pepsinogen (group A)Serum pepsinogen (group A): Serum pepsinogen group A decreased in humans after successful Helicobacter pylori eradication with bismuth-containing agents (139). Ranitidine bismuth citrate had no effect on plasma pepsinogen I and II concentrations vs. ranitidine alone (140). Urinary pHUrinary pH: Use of bismuth subnitrate medications caused a slight increase in the pH of urine in a clinical trial (137). X-rayX-ray: Radio-opaque punctate opacities were found on chest radiographs following intravenous injection of a bismuth compound (119).