Bismuth

Related Terms

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 phosphate, 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), 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?.
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.

Background

Bismuth (Bi) is a chemical element whose atomic number is 83. Bismuth-containing compounds include cosmetics (bismuth oxychloride) and certain drugs. Bismuth is also used in some medical procedures. Bismuth has been used for approximately a hundred years for stomach and intestinal conditions and was the first drug shown to affect the progression of peptic ulcer disease. The historical use of bismuth has been discussed in various reviews.
Although the element bismuth has been used since at least the 18th Century, most bismuth-containing products available on the market now are multi-ingredient products or are used in combination with other drugs. These multi-ingredient products will be only briefly 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.
Some preliminary evidence suggests that bismuth carbomer enemas may reduce pouchitis (inflammation in the pouch) that may occur after colon removal. Bismuth subnitrate has been used for treatment of Helicobacter pylori infection, typically in combination with antibiotics, with limited evidence of benefit. Bismuth subgallate has been studied for controlling odor after an ileostomy (a hole surgically constructed in the abdomen to eliminate waste).

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


According to human research, bismuth subnitrate may reduce the acidity of the stomach, as well as increase the production of a substance that improves ulcer healing. Also, a bismuth-protein complex may coat ulcers and allow healing to occur. Bismuth therapy for gastritis has been investigated in a few preliminary clinical trials. Well-designed studies are required before conclusions can be drawn.

 C


According to human research, bismuth subnitrate may reduce the acidity of the stomach, as well as increase the production of a substance that improves ulcer healing. Also, a bismuth-protein complex may coat ulcers and allow healing to occur. Bismuth therapy for gastritis has been investigated in a few preliminary clinical trials. Well-designed studies are required before conclusions can be drawn.

 C


Bismuth has been used traditionally for stomach problems. Limited research has investigated the use of bismuth subgallate to control the odor associated with ileostomies (a surgical opening in the belly wall to allow waste to be removed). Further well-designed trials are required before conclusions can be drawn.

 C


Bismuth has been used traditionally for stomach problems. Limited research has investigated the use of bismuth subgallate to control the odor associated with ileostomies (a surgical opening in the belly wall to allow waste to be removed). Further well-designed trials are required before conclusions can be drawn.

 C


Bismuth has been established as a safe and well-tolerated treatment for Helicobacter pylori infections in adults and children. Limited research suggests that the addition of bismuth subnitrate to other medications, such as antibiotics, may improve the elimination of bacteria over the other medications alone. Further studies are needed before conclusions can be drawn.

 C


Bismuth has been established as a safe and well-tolerated treatment for Helicobacter pylori infections in adults and children. Limited research suggests that the addition of bismuth subnitrate to other medications, such as antibiotics, may improve the elimination of bacteria over the other medications alone. Further studies are needed before conclusions can be drawn.

 C


According to research in humans, bismuth subnitrate, ginseng, and tang-kuei ten may reduce kidney dysfunction associated with cisplatin treatment, although conflicting results exist. Furthermore, at least one case study suggests that high doses of bismuth may cause sudden and severe kidney failure. More information is needed before conclusions can be drawn.

 C


According to research in humans, bismuth subnitrate, ginseng, and tang-kuei ten may reduce kidney dysfunction associated with cisplatin treatment, although conflicting results exist. Furthermore, at least one case study suggests that high doses of bismuth may cause sudden and severe kidney failure. More information is needed before conclusions can be drawn.

 C


Bismuth has been used traditionally for gastric concerns. The use of bismuth subgallate to control the odor associated with ileostomies (a surgical opening in the belly wall to allow waste to be removed) was investigated in humans. Also, limited research indicates that bismuth may prevent ulcer recurrence similarly to cimetidine. Further information is required before conclusions can be drawn.

 C


Bismuth has been used traditionally for gastric concerns. The use of bismuth subgallate to control the odor associated with ileostomies (a surgical opening in the belly wall to allow waste to be removed) was investigated in humans. Also, limited research indicates that bismuth may prevent ulcer recurrence similarly to cimetidine. Further information is required before conclusions can be drawn.

 C


A limited number of studies have investigated the use of bismuth carbomer enemas for chronic pouchitis, which is the inflammation of a surgically constructed bowel pouch. However, the results from these studies were conflicting, so further information is required before conclusions can be drawn.

 C


A limited number of studies have investigated the use of bismuth carbomer enemas for chronic pouchitis, which is the inflammation of a surgically constructed bowel pouch. However, the results from these studies were conflicting, so further information is required before conclusions can be drawn.

 C


A limited number of studies have investigated the use of bismuth subgallate for tonsillectomy (tonsil removal). Although evidence from clinical trials examining the effect of gauze containing bismuth and adrenaline suggests improved healing, only one of two trials examining the effect of bismuth alone agreed with these results. Further information is required before conclusions can be drawn.

 C


A limited number of studies have investigated the use of bismuth subgallate for tonsillectomy (tonsil removal). Although evidence from clinical trials examining the effect of gauze containing bismuth and adrenaline suggests improved healing, only one of two trials examining the effect of bismuth alone agreed with these results. Further information is required before conclusions can be drawn.

 C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Dosing

Adults (18 years and older)
For most conditions, 400-800 milligrams of combined bismuth nitrate and bismuth aluminate, 200 milligrams of bismuth subgallate, 240 milligrams bismuth subcitrate, and 300-700 milligrams of bismuth subnitrate have been given by mouth.
For gastritis, 400-800 milligrams of combined bismuth nitrate and bismuth aluminate has been given by mouth for four weeks.
For gastrointestinal conditions, 200 milligrams of bismuth subgallate has been given by mouth twice daily for one week.
For Helicobacter pylori infections, 240 milligrams of bismuth subcitrate has been given by mouth twice daily for 10 days as a combination therapy. Also, 400-800 milligrams of combined bismuth nitrate and bismuth aluminate has been given by mouth for four weeks. For other infections, colloidal bismuth subcitrate (one tablet four times daily) and bismuth subnitrate (two tablets three times daily) have been given by mouth for four weeks in combination with antibiotics.
For peptic ulcers, 700 milligrams of bismuth subnitrate has been given by mouth three times daily for four weeks. For duodenal ulcers, 300 milligrams of micronized bismuth subnitrate has been given by mouth six times daily for one month.
For pouchitis, bismuth carbomer has been given as an enema for 45 days. Bismuth carbomer (containing 270 milligrams of bismuth) has been given as foam enemas for three weeks.
For wounds on the roof of the mouth, bismuth subgallate paste has been applied to the skin.
For tonsillitis, 30 milligrams of bismuth subgallate has been applied to the skin as a combination therapy. An unknown dose of bismuth added to 20 milliliters of saline has been applied to the skin on swabs.
For kidney disorders (renal cysts), 0.1-0.6 grams of bismuth phosphate has been injected through the skin.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. 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. Consult a healthcare provider immediately if you experience side effects.

Interactions

Interactions with Drugs
In general, most drug interactions resulting from bismuth-containing products are caused by other ingredients in the products.
Bismuth-containing products may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
Bismuth-containing products may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin?) or heparin, antiplatelet drugs such as clopidogrel (Plavix?), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin?, Advil?) or naproxen (Naprosyn?, Aleve?).
Bismuth-containing products may interact with agents that bind to opiate receptors, antacids, cisplatin, metronidazole, omeprazole, phenytoin, probenecid, quinolone antibiotics, salicylates, sulfinpyrazone, and tetracycline antibiotics.

Attribution

This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

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