Long-term effects of bismuth subsalicylate (a.k.a. Pepto Bismol)?
December 17, 2014 8:20 PM   Subscribe

I'm looking for scientific articles on the topic. I understand that the mechanism of action is not well understood but I'm curious about the existence of any long-term effects.

I don't take it daily, maaaaybe once a week? If that?

My issue is dairy. I'm not lactose intolerant (I know this because Lactaid might as well be sugar pills) but when I take Pepto, for some reason it works like a charm. Especially when I take it before I eat something with cheese. I was diagnosed with IBS and all my symptoms disappear when I eat gluten free, and I've stuck to the diet for 6 years. But every once in a while, I want a freakin' slice of GF pizza. With REAL cheese, none of that Daiya crap. So I eat it. And then I take some Pepto. I'm hoping the long term effects aren't bad, but I can't find any info on the topic.
posted by onecircleaday to Health & Fitness (4 answers total) 2 users marked this as a favorite
IANAD and IANYD, but Wikipedia cites this article as saying that use of longer than 6 weeks can lead to salicylism. You probably don't want that. That said, that's with using it every single day, and it doesn't sound like you're doing that.

Talk to your gastroenterologist, but this doesn't sound like a serious risk to me with your level of use.
posted by fifthrider at 9:30 PM on December 17, 2014 [1 favorite]

IANYD, but once a week should be ok. Daily, 8 tabs a day is even ok for six weeks, but not much longer, due to bismuth poisoning.
posted by OneSmartMonkey at 9:44 PM on December 17, 2014

The amount of salicylate in a dose of Pepto Bismol is similar to the amount in an aspirin (which is essentially salicylate). Many people take a baby aspirin or even a full aspirin daily for its health benefits for many years of their lives - although there are also health risks, particularly irritation and bleeding from the GI tract, those are more of a concern with daily use than with once once per week. Bismuth is an element that occurs in trace amounts in everyone's diet, and also most (99%) of orally ingested bismuth is fecally excreted without being absorbed (see linked paper above which cites this figure) - these two facts should be reassuring. That being said, I could not find any actual studies on long term effects and based on what I read, I don't think there is a lot of literature on the subject. With something like bismuth that is, drug-wise, considered quite safe, you'd have to do a very large study to detect small negative side effects over time due to the way statistics and powering of studies works.

I'd like to point out in regards to the interesting case study of bismuth toxicity linked above that the woman in question was taking Pepto Bismol 3 times daily for 2 months, and had increased her dosing above that amount for several weeks - which is a LOT of Pepto Bismol. The paper notes: "One reason why bismuth toxicity is often hard to diagnose is because of its low incidence. In one meta-analysis of patients taking bismuth compounds to eradicate H pylori, no adverse neurologic effects were recorded across 35 randomly controlled trials, including 11 studies in which the patients took the bismuth compound for greater than 1 month."

If you have an IBS diagnosis, you likely have a GI doctor, so they might have a better answer for you on this subject - and if you know a good pharmacist, might be interesting to ask them too. They might be more familiar with any existing literature.
posted by treehorn+bunny at 10:13 PM on December 17, 2014 [5 favorites]

I was curious, so I requested the article that fifth rider cites from my medical library (S. Gorbach author). It was delivered today and I just wanted to let you know what it says.

"At a low dose of bismuth subsalicylate, the relationship between the dose and the recovery is linear, but multi-dose regimens show a non-linear relationship, with a tendency for salicylate accumulation."

Translation: if you take a single dose once in a while, your body will eliminate the salicylate normally and you are not at risk for salicylate toxicity. Another interesting point in the paper suggested that because aspirin's chemical makeup is in fact slightly different than salicylate, that it was less likely to cause gastric ulceration because it is a weaker acid.

The part about bismuth accumulation is too lengthy to transcribe, but it essentially says that the tiny amount of bismuth that IS absorbed by the GI tract is thought to be stored in your body tissues and excreted in your urine for up to 3 months after ingestion. Considering that, as noted previously, bismuth is in most everyone's diet and this process is likely constantly going on in everyone's body, it isn't clear whether there is any harm from you storing a little more bismuth in your system than everyone else.

The paper suggests that people who take courses of daily treatment for 6 weeks with BSS take a 6 to 8 week break from the medication to allow all the stored heavy metal to be excreted before taking it again, the idea being that even if you take a pretty low dose, if you take more than your body can excrete, over time eventually you'll build up enough heavy metal in your system that it could be toxic. I'm not a pharmacist and not good enough to calculate whether your current regimen is enough to allow any buildup of bismuth - I suspect it's not, given the parameters above, but if you wanted to be very safe you could be sure that every couple of months you take a 2 month break from it to allow it to clear.
posted by treehorn+bunny at 9:40 AM on December 19, 2014 [1 favorite]

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