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Updated: Oct 28 2019

Bismuth / Sucralfate

  • Snapshot
    • 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.
  • Introduction
    • 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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