Bismat

Indications

Bismuth subcitrate (also called colloidal bismuth subcitrate or tripotassium dicitratobismuthate) is used to treat stomach (gastric) and duodenal ulcers. It is also used as part of combination treatment, together with antibiotics and an acid-reducing medicine, to clear Helicobacter pylori, a bacterium that causes many ulcers and chronic stomach inflammation.

How It Works

In the acid of the stomach, bismuth subcitrate forms a protective coating that sticks to the ulcer base and shields it from acid and digestive enzymes while it heals. It also boosts the stomach lining's own defences (mucus and bicarbonate) and has a direct killing effect on Helicobacter pylori.

Dosage and Administration

Take as prescribed by your doctor. For ulcers, the usual adult dose is 120 mg four times a day (30 minutes before each of the three main meals and at bedtime) or 240 mg twice a day (30 minutes before breakfast and the evening meal), usually for 4 to 8 weeks. Do not take it for more than 8 weeks at a time. For Helicobacter pylori, it is taken together with other medicines for 10 to 14 days exactly as the doctor directs. Swallow the tablets with water. Do not take milk, antacids or food within 30 minutes before or after a dose.

Interactions

• Antacids, milk and food reduce its effect; separate by at least 30 minutes.
• It can reduce the absorption of Tetracycline antibiotics, iron and some other medicines taken at the same time; follow your doctor's timing, especially in Helicobacter pylori regimens.
• Do not take other bismuth-containing products at the same time, to avoid too much bismuth building up.

Contraindications

• Allergy to bismuth or any ingredient.
• Severe kidney impairment.
• Pregnancy.

Side Effects

It commonly darkens the stools to black and may darken the tongue; this is harmless and goes away after stopping. Other effects can include nausea, vomiting, constipation, diarrhoea and mild headache. Long-term or excessive use can cause bismuth to build up and affect the brain (confusion, unsteadiness, muscle twitching).

Get urgent medical help if you vomit blood or material like coffee grounds, have black sticky stools with dizziness or weakness (which may mean bleeding rather than the harmless colour change), develop confusion, trouble walking or speaking, or have a severe allergic reaction with swelling or difficulty breathing.

Pregnancy and Lactation

Bismuth subcitrate should not be used during pregnancy. It is not known how much passes into breast milk, so it is usually avoided while breastfeeding unless the doctor advises otherwise.

Precautions and Warnings

• Do not use for longer than 8 weeks or at higher doses than prescribed.
• Use with care in people with reduced kidney function.
• Tell your doctor if you have warning signs such as weight loss, difficulty swallowing or persistent vomiting before starting, as these need investigation.
• Not usually recommended for children.

Overdose

Large or long-term overdose can damage the kidneys and nervous system. Get emergency medical help straight away if too much has been taken.

Therapeutic Class

Ulcer-healing agent, gastric mucosal protectant (bismuth compound).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.