Mode of action
Forms an acid- and pepsin-resistant protective coating at the ulcer site. May also have antibacterial effects against
H. pylori.
Indications
H. pylori eradication (with other agents) after failure of first line treatments.
Contraindications
Severe renal impairment.
Specific considerations
Pregnancy: Avoid use; bismuth is a heavy metal that crosses the placenta; ADEC category B2.
Breastfeeding: Avoid use; excreted in breast milk.
Adverse effects
Common: blackening of faeces, darkening of teeth and tongue.
Infrequent: nausea, vomiting, dizziness, headache, diarrhea.
Dosage
H. pylori eradication: 1 tablet 4 times daily for 10–14 days.
Administration instructions
Take on an empty stomach; chew tablets before swallowing.
Food or milk may bind with bismuth subcitrate and reduce its efficacy.
Practice points
if a further course is required for ulcer healing, repeat treatment after a 4–8-week interval.
Products
BISMUTH SUBCITRATE, COLLOIDAL TABS 120 MG (AS BISMUTH III OXIDE) (DE-NOL®)