Overview

Bismuth (Bi) is a chemical element with the atomic number 83. Bismuth supplements usually contain bismuth in a salt form, such as bismuth subsalicylate.

Bismuth salts seem to help eliminate bacteria that cause stomach problems such as diarrhea and stomach ulcers. Bismuth salts also work like an antacid to treat problems such as indigestion. Bismuth might also speed up blood clotting.

People commonly use bismuth for travelers' diarrhea, a digestive tract infection that can lead to ulcers (Helicobacter pylori or H. pylori), and stomach ulcers. It is also used for constipation, bleeding, and many other conditions, but there is no good scientific evidence to support these other uses.

Bismuth supplements are available in many different salt forms. Bismuth nitrate is a specific form that is not legal for use in dietary supplements. Review the listing on bismuth nitrate for more details.



Uses & Effectiveness

Likely Effective for

  • Travelers' diarrhea. Bismuth subsalicylate is effective for treating and preventing travelers' diarrhea.

Possibly Effective for

  • A digestive tract infection that can lead to ulcers (Helicobacter pylori or H. pylori). Taking bismuth by mouth along with standard antibiotics might improve healing from H. pylori.
  • Stomach ulcers. Taking bismuth subsalicylate by mouth, alone or with other treatments, seems to help treat and prevent stomach ulcers.

There is interest in using bismuth for a number of other purposes, but there isn't enough reliable information to say whether it might be helpful.

Side Effects

When taken by mouth: Bismuth subgallate and bismuth subsalicylate are likely safe for most people when used as directed. Other forms of bismuth salts are possibly safe when used short-term. Bismuth salts, including ranitidine bismuth citrate, colloidal bismuth subcitrate, and bismuth subnitrate appear to be safe when taken in doses of 400-2100 mg daily for up to 56 days.

Bismuth is possibly unsafe when used in larger amounts due to the risk for kidney failure, and when taken long-term due to the risk of nerve damage.

Special Precautions and Warnings

When taken by mouth: Bismuth subgallate and bismuth subsalicylate are likely safe for most people when used as directed. Other forms of bismuth salts are possibly safe when used short-term. Bismuth salts, including ranitidine bismuth citrate, colloidal bismuth subcitrate, and bismuth subnitrate appear to be safe when taken in doses of 400-2100 mg daily for up to 56 days.

Bismuth is possibly unsafe when used in larger amounts due to the risk for kidney failure, and when taken long-term due to the risk of nerve damage.

Pregnancy and breast-feeding: There isn't enough reliable information to know if bismuth is safe to use when pregnant or breast-feeding. Stay on the safe side and avoid use.

Children: Bismuth subgallate and bismuth subsalicylate are likely safe when taken by mouth short-term. Taking 200-400 mg of bismuth subgallate by mouth up to four times daily is approved by the US FDA as a deodorant drug for children at least 12 years old. Taking 1.05 grams of bismuth subsalicylate by mouth hourly as needed (no more than 4.2 grams daily) for up to 2 days is approved by the US FDA for diarrhea in children at least 12 years old. There isn't enough reliable information to know if it is safe for children to take other bismuth salts. Bismuth is possibly unsafe when taken by mouth in large amounts or long-term.

Allergy to salicylate: Many bismuth supplements contain the bismuth salt called bismuth subsalicylate. Bismuth subsalicylate breaks down in the stomach to form bismuth and salicylate. People who are sensitive to salicylate might have a serious side effect to these supplements.

Gastrointestinal (GI) conditions: Normally, almost no bismuth is absorbed by the gut. But having certain GI conditions might increase how much bismuth is absorbed. This might increase the side effects of bismuth.

Interactions

    Moderate Interaction

    Be cautious with this combination

  • Aspirin interacts with Bismuth

    Many dietary supplements contain bismuth in the form of bismuth subsalicylate. When taken by mouth, bismuth subsalicylate is broken down into bismuth and salicylate. Because aspirin contains salicylate, taking bismuth with aspirin might increase the effects and side effects of aspirin.

  • Omeprazole (Prilosec) interacts with Bismuth

    Omeprazole increases how much bismuth the body absorbs. Taking omeprazole with bismuth might increase the effects and side effects of bismuth.

  • Warfarin (Coumadin) interacts with Bismuth

    Bismuth subsalicylate might decrease the effects of warfarin. People using warfarin should avoid using bismuth subsalicylate. However, this interaction is not likely to be a concern for other bismuth salts.

  • Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs) interacts with Bismuth

    Bismuth might slow blood clotting. Taking bismuth along with medications that also slow blood clotting might increase the risk of bruising and bleeding.

Dosing

Bismuth salts have most often been used by adults in doses of 300-2000 mg by mouth daily in 2-4 divided doses for up to 8 weeks. Speak with a healthcare provider to find out what dose might be best for a specific condition.
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