Name | Bismuth subsalicylate |
CAS number | 14882-18-9 |
EINECS number | 238-953-1 |
Synonym | Bismuth oxide salicylate; Bismuth subsalicylate; 4H-1,3,2-Benzodioxabismin-4-one, 2-hydroxy- |
Description | Bismuth subsalicylate is a multifaceted gastrointestinal agent combining antimicrobial, anti-inflammatory, antisecretory, and cytoprotective properties. It is effective for symptomatic relief of diarrhea, nausea, indigestion, and other stomach discomforts, as well as for prevention and treatment of traveler’s diarrhea and as part of H. pylori eradication regimens. Its pharmacological effects stem from the hydrolysis products bismuth salts and salicylic acid, which act locally in the gut and systemically, respectively. |
Structure |  |
Molecular Formula | C7H5BiO4 |
Molecular Weight | 362.09 g/mol |
Appearance | Solid powder |
Quality Standard | USP Standard |
Assay | ≥98% |
Shipping Condition | Shipped under ambient temperature as non-hazardous chemical. This product is stable enough for a few weeks during ordinary shipping and time spent in Customs. |
Storage Condition | Store in cool place. Keep container tightly closed in a dry and well ventilated place. |
Shelf Life | >2 years if stored properly |
Sample package | Aluminium foil bag |
Commercial package | Aluminium Tin, Fiber drum |
Origin | China |
Bismuth subsalicylate More Info
Bismuth subsalicylate is an over-the-counter medication widely used as an antidiarrheal, antacid, and anti-inflammatory agent to treat temporary stomach and gastrointestinal discomforts such as nausea, indigestion, upset stomach, heartburn, and diarrhea.
Mechanism of Action
Antimicrobial and Antisecretory Effects: After oral administration, bismuth subsalicylate hydrolyzes in the stomach into bismuth oxychloride and salicylic acid. The bismuth salts formed in the gastrointestinal tract exhibit bactericidal activity by preventing bacteria, including Helicobacter pylori, Escherichia coli, Clostridium difficile, Salmonella, and Shigella, from adhering to and growing on mucosal cells. This reduces intestinal secretion and fluid loss while promoting fluid and electrolyte reabsorption.
Anti-inflammatory Action: The salicylic acid component inhibits cyclooxygenase enzymes, reducing prostaglandin synthesis, thereby decreasing inflammation and irritation of the stomach and intestinal lining.
Cytoprotective Effects: Bismuth subsalicylate promotes healing of pre-existing ulcers and has demulcent properties that protect the gastrointestinal mucosa.
Additional Actions: It reduces gastrointestinal hypermotility and gas formation, contributing to relief from flatulence and discomfort.
Applications
Symptomatic treatment of nausea, heartburn, indigestion, upset stomach, and diarrhea.
Prevention and treatment of traveler’s diarrhea, with a protection rate exceeding 60% in some studies.
Part of quadruple therapy regimens for eradication of H. pylori infection associated with duodenal ulcers.
Routes of Administration
Oral: Available as chewable tablets, liquid suspensions (e.g., Pepto-Bismol), and capsules.
Pharmacokinetics
Absorption: Salicylic acid released from bismuth subsalicylate is almost completely absorbed in the small intestine, reaching peak plasma concentrations within 1 to 2 hours post-dose. Bismuth itself is minimally absorbed (<1%) and mostly remains within the gastrointestinal tract.
Distribution: Salicylic acid is about 90% plasma protein bound; bismuth is over 90% plasma protein bound when absorbed.
Metabolism: Bismuth subsalicylate hydrolyzes in the acidic stomach environment to bismuth oxychloride and salicylic acid. In the intestines and colon, bismuth reacts with anions and bacterial hydrogen sulfide to form insoluble salts like bismuth sulfide, which causes black discoloration of stools and tongue.
Elimination: Salicylic acid is excreted primarily via urine; bismuth is eliminated through urinary and biliary routes. Salicylic acid has a half-life of 2 to 5 hours, while bismuth has a longer half-life ranging from 5 to 11 days (intermediate) and 21 to 72 days (terminal).
Safety and Side Effects
Common Side Effects:
Temporary black discoloration of the tongue and stools due to bismuth sulfide formation; this is harmless and reversible.
Mild gastrointestinal discomfort.
Serious Side Effects (Rare):
Overuse or prolonged use may cause salicylate toxicity with symptoms such as anxiety, confusion, severe headache, slurred speech, hearing loss, ringing in ears, severe abdominal pain, constipation or diarrhea, muscle spasms, or weakness.
Allergic reactions are uncommon.
Precautions:
Avoid use in patients allergic to salicylates or aspirin.
Avoid concurrent use with other salicylates or NSAIDs to prevent overdose.
May interfere with absorption of certain antibiotics (e.g., doxycycline); dosing should be spaced accordingly.
Use cautiously in children and teenagers recovering from viral infections due to risk of Reye’s syndrome.
Not recommended for prolonged use beyond indicated durations (typically no more than 2–3 weeks for prevention, 8 doses per 24 hours for treatment).
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