Updated: 10/28/2019

Bismuth / Sucralfate

Review Topic
  • A 19-year-old college student presents to the university travel clinic for an evaluation prior to embarking on a global health research project in northern India. She has no significant medical history, and has a copper intrauterine device for birth control. Her physical exam is grossly unremarkable. In addition to vaccinations, the physician suggests that the patient purchase Pepto-Bismol over the counter to manage any traveler's diarrhea while abroad, but recommends avoiding concomitant consumption of aspirin.
  • Drugs
    • bismuth subsalicylate
    • sucralfate
  • Mechanism of action
    • provides physical protection to ulcer base
      • requires low pH to activate into paste consistency that adheres to mucosal wall
        • may be inhibited by antacids
        • may decrease absorption of other medications
      • does not decrease acid secretion or neutralize acid response
  • Clinical use
    • peptic ulcer disease 
      • ↑ ulcer healing
      • ↓ ulcer recurrence
    • traveler's diarrhea
    • triple therapy of H. pylori ulcers
      • bismuth subsalicylate
      • metronidazole 
      • tetracycline (or amoxicillin) 
        • may also use proton pump inhibitor 
  • Adverse effects
    • sucralfate
      • constipation
    • bismuth subsalicylate
      • harmless black coloring of stool
      • Reye's syndrome in children recovering from chickenpox or influenza (due to salicylate component)

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