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Indications and Dosage
Oral
Benign gastric and duodenal ulceration Adult: 240 mg bid or 120 mg 4 times daily for 4 wk, may be extended to 8 wk if needed. May also be repeated after one mth of drug-free interval. Oral H. pylori infection Adult: 120 mg 4 times daily in combination with other drugs given for 2 wk.
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Renal Impairment
Moderate-severe impairment: Avoid use.
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Contraindications
Moderate-severe renal insufficiency. Pregnancy, child <14 yr.
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Special Precautions
Lactation. Monitor renal function regularly.
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Adverse Reactions
Darkening of tongue or stools. Nausea, vomiting, bone and joint toxicity.
Potentially Fatal: Possibility of bismuth poisoning and fatal encephalopathy in patients with renal impairment or if given over prolonged periods. Renal failure and liver damage. |
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Overdosage
Overdosage may lead to serious adverse effects such as renal failure, encephalopathy and neurotoxicity. May consider gastric lavage, purgation and hydration. Chelating agents may be useful.
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Drug Interactions
Food, milk, antacids, tetracyclines and H2-receptor antagonists reduce activity of drug.
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Action
Description: Bismuth subcitrate is used in the management of gastric and duodenal ulcers and specifically against H.pylori as part of a triple drug regimen. It exerts bactericidal action against H.pylori which is accepted to be the causative factor in chronic gastritis and duodenal ulcer.
Pharmacokinetics: Absorption: Slightly absorbed (oral); increased absorption with increased gastric pH. Distribution: Throughout body tissues, bones (absorbed bismuth). Metabolism: Poorly soluble bismuth compounds are mostly converted to insoluble bismuth oxide, hydroxide and oxychloride in acidic pH of the stomach. Excretion: Faeces (unabsorbed bismuth); urine (absorbed bismuth); 5 days (plasma half-life). |
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Storage
Store below 25°C.
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MIMS Class
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