Bismuth subsalicylate
Bismuth subsalicylate, with a nominal chemical formula of C7H5BiO4, It is a colloidal substance obtained by hydrolysis of bismuth salicylate (Bi{C6H3(OH)CO2}3). The actual structure is unknown and the formulation is only approximate. Recent evidence indicates that it is composed of a bismuth oxide core structure with salicylate ions attached to the surface. A model structure has recently been published having the composition Bi38O44{C6H3(OH)CO2}26. It is a drug used to treat temporary discomforts of the stomach
The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...

 and gastrointestinal tract
Gastrointestinal tract
The human gastrointestinal tract refers to the stomach and intestine, and sometimes to all the structures from the mouth to the anus. ....

, such as diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...

, heartburn
Heartburn, also known as pyrosis or acid indigestion is a burning sensation in the chest, just behind the breastbone or in the epigastrium...

 and nausea
Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...

. Commonly known as pink bismuth, it is the active ingredient in popular medications such as Pepto-Bismol
Pepto-Bismol is an over-the-counter drug currently produced by the Procter and Gamble company in the United States of America and in Canada to treat minor digestive system upset. Its active ingredient is bismuth subsalicylate...

 and modern (since 2003) Kaopectate
Kaopectate, known medically as bismuth subsalicylate, is an orally taken medication from Chattem, Inc. for the treatment of mild diarrhea. It is also sometimes used to treat indigestion, nausea and stomach ulcers...



As a derivative of salicylic acid
Salicylic acid
Salicylic acid is a monohydroxybenzoic acid, a type of phenolic acid and a beta hydroxy acid. This colorless crystalline organic acid is widely used in organic synthesis and functions as a plant hormone. It is derived from the metabolism of salicin...

, bismuth
Bismuth is a chemical element with symbol Bi and atomic number 83. Bismuth, a trivalent poor metal, chemically resembles arsenic and antimony. Elemental bismuth may occur naturally uncombined, although its sulfide and oxide form important commercial ores. The free element is 86% as dense as lead...

 salicylate displays anti-inflammatory
Anti-inflammatory refers to the property of a substance or treatment that reduces inflammation. Anti-inflammatory drugs make up about half of analgesics, remedying pain by reducing inflammation as opposed to opioids, which affect the central nervous system....

 action and also acts as an antacid
An antacid is a substance which neutralizes stomach acidity.-Mechanism of action:Antacids perform a neutralization reaction, increasing the pH to reduce acidity in the stomach. When gastric hydrochloric acid reaches the nerves in the gastrointestinal mucosa, they signal pain to the central nervous...


Mechanism of action

Bismuth subsalicylate is used as an antidiarrheal
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...

 and to treat some other gastro-intestinal diseases (oligodynamic effect
Oligodynamic effect
The oligodynamic effect was discovered in 1893 by the Swiss Karl Wilhelm von Nägeli as a toxic effect of metal ions on living cells, algae, molds, spores, fungi, viruses, prokaryotic and eukaryotic microorganisms, even in relatively low concentrations...

The means by which this appears to work is still not well documented. It is thought to be some combination of:
  • Retarding the expulsion of fluids into the digestive system by irritated tissues, by "coating" them.
  • Reducing inflammation/irritation of stomach and intestinal lining
  • Killing some bacteria that cause diarrhea

Adverse effects and contraindications

There are some adverse effects
Adverse effect (medicine)
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...

. It can cause a black tongue and black stools
Feces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus or cloaca during defecation.-Etymology:...

 in some users of the drug, when it combines with trace amounts of sulfur
Sulfur or sulphur is the chemical element with atomic number 16. In the periodic table it is represented by the symbol S. It is an abundant, multivalent non-metal. Under normal conditions, sulfur atoms form cyclic octatomic molecules with chemical formula S8. Elemental sulfur is a bright yellow...

 in saliva and the gastrointestinal tract to form bismuth sulfide. This discoloration is temporary and harmless.

Some of the risks of salicylism can apply to the use of bismuth subsalicylate.

Children should not take medication with bismuth subsalicylate while recovering from influenza
Influenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family Orthomyxoviridae , that affects birds and mammals...

 or chicken pox, as epidemiologic evidence points to an association between the use of salicylate-containing medications during certain viral infections and the onset of Reye's syndrome
Reye's syndrome
Reye's syndrome is a potentially fatal disease that causes numerous detrimental effects to many organs, especially the brain and liver, as well as causing a lower than usual level of blood sugar . The classic features are liver damage, aspirin use and a viral infection...

. For the same reason, it is typically recommended that nursing mothers not use medication containing bismuth subsalicylate (such as Pepto-Bismol) because small amounts of the medication are excreted in breast milk and pose a theoretical risk of Reye's syndrome to nursing children.


Bismuth subsalicylate is the only active ingredient in an over the counter medication that will leave a shiny metal oxide slag
Slag is a partially vitreous by-product of smelting ore to separate the metal fraction from the unwanted fraction. It can usually be considered to be a mixture of metal oxides and silicon dioxide. However, slags can contain metal sulfides and metal atoms in the elemental form...

 behind after being completely burnt with a blow torch
Blow torch
A blowtorch , blow torch , or blowlamp is a tool for applying lower-intensity and more diffuse flame and heat for various applications, than the oxyacetylene torch. Before aerosol cans and pressurized gas cylinders, fuel was pressurized by a syringe or pump...

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