Herb & supplement monograph

Bismuth Drug Interactions, Uses, Effectiveness, Safety & More

Medically reviewed by ·Updated July 2026
What is this page for?

First and foremost: how Bismuth interacts with medications. The heart of this page is the interaction list — every drug Bismuth is known to interact with, and how serious each one is.

But these pages have grown well beyond that into a full monograph — what Bismuth is, what people use it for and how strong the evidence is, its safety and side effects, and answers to the questions we’re asked most — written and reviewed by the clinical staff at HelloPharmacist. It’s educational information from our licensed clinical databases, not medical advice, and we don’t sell or endorse products. Our editorial policy

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Interaction report

Drugs that interact with Bismuth

125 medications have a known interaction with Bismuth, graded by severity. Select any drug for the full evidence-based detail.

2,830 drugs
AbciximabReoPro› AbrocitinibCibinqo› AcenocoumarolSintrom› Acetaminophen, AspirinGemnisyn› Acetaminophen, Aspirin, CaffeineExcedrin, Excedrin Extra Strength, Excedrin Migraine› Acetaminophen, IbuprofenCombogesic› Acetylsalicylic AcidEntrophen› Alteplase, TpaActilyse, Activase› Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium HydroxideAscriptin Codeine #2› Aluminum Hydroxide, Aspirin, Magnesium HydroxideAscriptin› Amoxicillin, Omeprazole Magnesium, RifabutinTalicia› Anacaulase-bcdbNexoBrid› AnagrelideAgrylin› AnisindioneMiradon› Antithrombin IiiThrombate III› ApixabanEliquis› ArgatrobanArgatroban› AspirinAngettes 75, ASA, Asaphen, Aspirin, Caprin, Cartia +8 more› Aspirin, Aluminum Hydroxide, Codeine Phosphate, Magnesium HydroxideAscriptin Codeine #3› Aspirin, ButalbitalAxotal› Aspirin, Butalbital, CaffeineFiorinal› Aspirin, Butalbital, Caffeine, Codeine PhosphateFiorinal w/ Codeine› Aspirin, Butalbital, Caffeine, PhenacetinMarnal› Aspirin, CaffeineAnacin› Aspirin, Caffeine, Codeine PhosphateAnacin w/ Codeine› Aspirin, Caffeine, Dihydrocodeine BitartrateSynalgos DC› Aspirin, Caffeine, Dover's PwdAcedoval, Dovacet› Aspirin, Caffeine, HydrocodoneDamason-P› Aspirin, Caffeine, Isobutylallylbarbituric Acid, PhenacetinLanorinal› Aspirin, Caffeine, OrphenadrineInvagesic, Invagesic Forte, Norgesic, Norgesic Forte, Orphengesic, Orphengesic Forte›
Read The List Like a Pharmacist

What Severity, Likelihood & Evidence Mean

Severity — How Serious It Can Be

  • Major. Clinically significant; generally best avoided, or used only under direct professional supervision.
  • Moderate. May need monitoring, a dose adjustment, or separating the times you take each one.
  • Minor. Generally not clinically significant, but still worth noting and mentioning to your pharmacist.
  • No known interaction. Checked against our sources with nothing documented — not the same as proven safety.

Likelihood — How Well It’s Documented

  • Likely. Well-controlled human studies have demonstrated the likely existence of this interaction
  • Probable. Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • Possible. Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists
  • Unlikely. Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans.

Where This Data Comes From

  • Interaction records are evidence-graded and sourced from the Natural Medicines database (TRC Healthcare), the same reference used by pharmacists and hospitals.
  • Each drug listed above links to the full report for that exact Bismuth combination — clinical detail, likelihood, evidence level, and citations.
  • Content is reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.
The big picture

The kinds of drugs Bismuth affects

Every type of medication (drug category) Bismuth is known to interact with. Open any category for the detail — or search your exact drug in the checker above.

All 4 drug categories Bismuth interacts with
Anticoagulant/antiplatelet DrugsAspirinOmeprazole (prilosec)Warfarin (coumadin)
Anticoagulant/Antiplatelet Drugs

Theoretically, use of bismuth subgallate or other bismuth salts might reduce the effects of anticoagulant/antiplatelet drugs.
In humans, bismuth subgallate activates factor XII and accelerates the coagulation cascade.

Likelihood Possible Evidence D
Aspirin

Theoretically, bismuth subsalicylate might have an additive effect with other salicylate-containing drugs.
Dietary supplements often contain bismuth in the form of bismuth subsalicylate. In humans, oral bismuth subsalicylate is hydrolyzed in the stomach to form salicylate and bismuth oxychloride.

Likelihood Possible Evidence D
Omeprazole (Prilosec)

Theoretically, concomitant use of bismuth and omeprazole may increase the effects and side effects of bismuth.
In humans, omeprazole increases the absorption of bismuth from tripotassium dicitrato bismuthate. The area under the concentration-time curve (AUC) and urinary excretion (Ae) of bismuth have been shown to be higher when tripotassium dicitrato bismuthate is administered with omeprazole (172 ± 158 mcg/L/hour and 1.9 ± 2.0 mg per eight hours, respectively) compared with administration alone (46 ± 33 mcg/L/hour and 0.27 ± 0.28 mg per eight hours, respectively).

Likelihood Possible Evidence B
Warfarin (Coumadin)

There is some concern that bismuth subsalicylate might increase the effects of warfarin.
In one case, a patient treated with warfarin had an increase in international normalized ratio (INR), from 2.56 to 3.54, following intake of bismuth subsalicylate 30 mL every 4 hours for 3 days. However, this interaction resulted from the displacement of warfarin from plasma protein binding sites by salicylate, which increased the free active form of warfarin. Therefore, this interaction is not likely to occur with other bismuth salts.

Likelihood Possible Evidence D
Monograph

Bismuth: Uses, Safety & Side Effects

Medically reviewed by · Reviewed July 2026 ·
The bottom line

Bismuth is a metallic element used in medicine mostly as bismuth subsalicylate (the active ingredient in some well-known stomach remedies) to ease upset stomach, heartburn, nausea, and diarrhea. It is generally well tolerated for short-term use, but it can cause harmless black stools or a dark tongue, and because most products contain salicylate, it carries cautions similar to aspirin. Always follow the label and check with a pharmacist before regular use.

Part used
Mineral element (not a plant); used as bismuth salts
Common forms
Chewable tablets, caplets, liquid suspensions (commonly as bismuth subsalicylate)
People commonly use it for
  • Upset stomach and indigestion
  • Diarrhea
  • Heartburn and nausea
  • Helicobacter pylori treatment (with other drugs)
  • Traveler's diarrhea prevention

Popular and traditional uses — not proof it works. See “Uses & effectiveness” below for the evidence.

Safety at a glance
OverallUse caution

Generally safe for short-term use, but most products contain salicylate and should not be overused.

PregnancyInsufficient reliable information

Insufficient reliable information available; avoid using.

Read the full pregnancy detail
BreastfeedingInsufficient reliable information

Insufficient reliable information available; avoid using.

Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center). Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

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Overview

Bismuth is a naturally occurring metallic element, not a plant or herb. In medicine and supplements, it is almost always used in the form of a bismuth salt. The most common one is bismuth subsalicylate, the active ingredient in several popular over-the-counter stomach remedies. Another form, bismuth subcitrate, is sometimes used in treatments for stomach ulcers.

People have used bismuth compounds for many years to soothe digestive complaints. Today it is taken mostly to relieve upset stomach, heartburn, nausea, indigestion, and diarrhea. It is also used as part of combination therapy prescribed by doctors to treat Helicobacter pylori, a bacteria linked to stomach ulcers.

How it works

Bismuth compounds are thought to work in several ways in the gut. They appear to coat the lining of the stomach and intestines, which may protect irritated tissue and reduce inflammation. This coating action may help calm nausea and upset stomach.

Bismuth also has mild antibacterial activity and can act against H. pylori, which is part of why it is included in ulcer-treatment regimens. In bismuth subsalicylate, the salicylate portion (chemically related to aspirin) may help reduce the secretion of fluid into the gut, which is helpful in diarrhea.

Much of what we know about the exact mechanisms comes from laboratory studies, so some details are still not fully understood.

Effectiveness

Does Bismuth work?

Here’s what the research actually shows for each use — graded by Natural Medicines and reviewed by .

Evidence overview · 10 uses evaluated
1 Likely effective 2 Possibly effective 7 Insufficient evidence
How to read these evidence grades

Natural Medicines’ 7-point scale. We show each rating’s label word-for-word.

1EffectiveStrong, consistent evidence it works.
2Likely EffectiveGood evidence, though not yet conclusive.
3Possibly EffectiveSome evidence suggests a benefit.
4Possibly IneffectiveSome evidence it may not help.
5Likely IneffectiveFairly strong evidence it doesn’t help.
6IneffectiveStrong evidence it doesn’t work.
7Insufficient Reliable Evidence to RateToo little research to say either way.
Likely Effective Travelers' diarrhea
Rating & evidence shown verbatim from Natural Medicines

Oral bismuth subsalicylate is effective for the treatment and prevention of travelers' diarrhea.

Possibly Effective Helicobacter pylori
Rating & evidence shown verbatim from Natural Medicines

The use of oral bismuth salts in combination with standard therapy, known as bismuth quadruple therapy (BQT), seems to improve H. Pylori eradication rates. Bismuth has also been evaluated as a component of other H. pylori treatment regimens, although the place of these regimens in clinical practice remains unclear.

Possibly Effective Peptic ulcers
Rating & evidence shown verbatim from Natural Medicines

Oral bismuth subsalicylate seems to help prevent and treat peptic ulcers, when used alone and in combination with other treatments, respectively.

Also studied for 7 conditions — evidence insufficient to rate
Insufficient Reliable Evidence To Rate Bariatric surgery complications
Rating & evidence shown verbatim from Natural Medicines

It is unclear if oral bismuth subgallate improves complications resulting from bariatric surgery.

Insufficient Reliable Evidence To Rate Cholera
Rating & evidence shown verbatim from Natural Medicines

Oral bismuth subsalicylate does not seem to improve the duration or severity of cholera symptoms.

Insufficient Reliable Evidence To Rate Dimethyl fumarate-induced side effects
Rating & evidence shown verbatim from Natural Medicines

Oral bismuth subsalicylate seems to improve the severity, but not the incidence, of gastrointestinal adverse effects resulting from dimethyl fumarate treatment.

Insufficient Reliable Evidence To Rate Ileostomy odor
Rating & evidence shown verbatim from Natural Medicines

Oral bismuth subgallate seems to improve odor related to ileostomy.

Insufficient Reliable Evidence To Rate Microscopic colitis
Rating & evidence shown verbatim from Natural Medicines

Oral bismuth subsalicylate seems to reduce stool frequency in patients with various subtypes of microscopic colitis.

Insufficient Reliable Evidence To Rate Minor bleeding
Rating & evidence shown verbatim from Natural Medicines

It is unclear if topical bismuth subgallate is beneficial for the treatment of minor bleeding; the available clinical research has yielded mixed findings.

Insufficient Reliable Evidence To Rate Pouchitis
Rating & evidence shown verbatim from Natural Medicines

It is unclear if administration of an enema containing bismuth improves symptoms or induces remission in patients with pouchitis.

Source & disclaimer. Effectiveness ratings and evidence summaries are provided by Natural Medicines (Therapeutic Research Center) and shown as licensed. Where Natural Medicines hasn’t rated a use, HelloPharmacist’s pharmacists may add their own reviewed rating and evidence (each such entry is labeled). This is educational information, not medical advice — talk with your pharmacist or doctor before starting, stopping, or changing a supplement.

Safety & precautions

For most healthy adults, bismuth subsalicylate is considered safe for short-term use at recommended doses. Because most products contain salicylate (an aspirin-like compound), some of the same cautions apply.

Children and teens recovering from flu or chickenpox should not take salicylate-containing products because of the risk of Reye's syndrome, a rare but serious condition. People with a salicylate or aspirin allergy, bleeding disorders, kidney problems, or a history of stomach bleeding should avoid bismuth subsalicylate unless a doctor approves.

Pregnancy: Bismuth subsalicylate is generally avoided during pregnancy, particularly in the second and third trimesters, because salicylates can affect the baby and pregnancy. Breastfeeding: Salicylate can pass into breast milk, so it is best to use caution and check with your doctor first. In both cases, talk to a pharmacist or doctor before using.

Side effects

The most common and harmless side effect is a temporary darkening of the stool (black stools) and sometimes the tongue. This is not dangerous and goes away after stopping the product, but black stools can be confused with the kind caused by internal bleeding, so let your provider know if you are unsure.

Other possible effects include mild constipation, nausea, or ringing in the ears. Ringing in the ears (tinnitus) can be a sign of taking too much salicylate and should prompt you to stop and seek advice.

Rarely, large or prolonged doses of bismuth have been linked to nervous system problems. Allergic reactions are uncommon but possible. Get medical help right away if you have signs of a serious reaction such as trouble breathing or swelling of the face or throat.

Bismuth: Reported Adverse Effects

Documented safety reports on Bismuth from the evidence-graded Natural Medicines (TRC Healthcare) database, shown word-for-word from the licensed record.

Orally, bismuth salts are generally well tolerated when taken alone or in combination with antibiotics.

Most Common Adverse Effects:

Orally: Change in taste perception, discolored stools or tongue, dizziness, gastrointestinal symptoms, such as nausea and diarrhea, and headache.

Serious Adverse Effects (Rare):

Orally: After large doses or chronic use, kidney failure and encephalopathy have been reported. Salicylate toxicity is also possible with use of bismuth subsalicylate specifically.

Reports by condition
Alopecia Dermatologic

Orally, alopecia due to bismuth therapy has been reported. A case of fixed drug eruption attributed to treatment with bismuth subcitrate has been confirmed with a drug challenge test. Pruritus was a side effect in clinical trials investigating bismuth with antibiotics. However, the effect of bismuth alone is unclear.

  1. GOELTNER, E. [Versenate treatment of alopecia following bismuth therapy]. Z Haut Geschlechtskr 1961;31:164-169.
  2. Galleani C, Bautista-Villanueva S, Barranco R, et al. Fixed drug eruption due to bismuth during Helicobacter pylori eradication therapy. J Allergy Clin Immunol Pract 2021;9(6):2503-2504.
  3. Pozzato, P., Zagari, M., Cardelli, A., Catalano, F. A., Giglio, A., Lami, F., Pilotto, A., Scarpulla, G., Spadaccini, A., Susi, D., Tosatto, R., Olivieri, A., Bazzoli, F., and Roda, E. Ranitidine bismuth citrate plus clarithromycin 7-day regimen is effect
  4. De Francesco V, Pontone S, Bellesia A, et al. Quadruple, sequential, and concomitant first-line therapies for H. pylori eradication: a prospective, randomized study. Dig Liver Dis 2018;50(2):139-41.
Anemia Hematologic

Orally, aplastic anemia has been reported as a potential side effect of bismuth salts. Lymphoid follicles are a reported side effect in a clinical trial investigating colloidal bismuth subcitrate in combination with tetracycline and furazolidone. However, the effect of bismuth alone is unclear. Excessive intake of bismuth subnitrate may cause methemoglobinemia.

  1. Moeschlin, S. [Clinical-hematological demonstrations: aplastic anemia, acute leukemias, polyneuropathy in Waldenstrom's disease, acute porphyria]. Schweiz Med Wochenschr 1975;105(40):1289-1298.
  2. Araujo Castillo, R., Pinto Valdivia, J. L., Ramirez, D., Cok Garcia, J., and Bussalleu Rivera, A. [New ultrashort scheme for helicobacter pylori infection eradication using tetracyline, furazolidone and colloidal bismuth subcitrate in dyspeptic patients w
  3. James JA. Acute renal failure due to a bismuth preparation. Calif Med 1968;109(4):317-9.
  4. Jacobsen JB, Hüttel MS. [Methemhemoglobinemia after excessive intake of a subnitrate containing antacid]. Ugeskr Laeger 1982;144(32):2349-50.
Anxiety Neurologic/CNS

Orally, multiple cases of bismuth-related neurotoxicity have been reported. In general, the risk of neurotoxicity from bismuth salts appears to be greater for colloidal bismuth than other forms due to the greater bioavailability of colloidal bismuth. In most cases, the neurotoxicity results from excessive use of bismuth salts over prolonged time periods (up to 30 years). Bismuth-related neurotoxicity often presents as encephalopathy that generally occurs in two phases. The first phase, which lasts for one week to several months, consists of nonspecific symptoms including depression, anxiety, irritability, phobias or delusions of persecution, somnolence, insomnia, hallucinations, headache, affect disorders, memory problems, attention disorders, and the inability to plan non-automatic activities. Unsteady gait, motor incoordination, and jerky movements may also occur. During the second phase, most patients experience mental confusion, pseudo-tremor along with myoclonic jerks, walking and standing disturbances, and dysarthria. The patients may also experience the inability to carry out simple instructions, sphincteric incontinence, muscle tone disturbances (hypotonia), and seizures. Recovery from encephalopathy may take weeks to months.

Because bismuth subsalicylate is hydrolyzed in the stomach to form salicylate and bismuth oxychloride, patients may present with salicylate toxicity following acute or chronic ingestion of bismuth subsalicylate. In one case, a 79-year-old patient with chronic kidney disease presented with a 1-week history of worsening confusion, inattention, and ataxia following ingestion of bismuth subsalicylate 8.3-16.6 grams daily for 6 months. The patient improved with supportive care and with discontinuation of bismuth subsalicylate.

Orally, other side effects of bismuth therapy, typically when used in combination with other medications including antibiotics and proton-pump inhibitors (PPIs), include dizziness, headache, and fatigue. However, when compared against non-bismuth containing regimens for Helicobacter pylori infection, the use of bismuth did not increase the risk of dizziness or headache.

  1. Mishkin, S. Intriguing gastrointestinal properties of bismuth: a folk remedy brought into the realm of clinical and investigative medicine. Can J Gastroenterol 1998;12(8):569-570.
  2. Supino-Viterbo V, Sicard C, Risvegliato M, Rancurel G, Buge A. Toxic encephalopathy due to ingestion of bismuth salts: clinical and EEG studies of 45 patients. J Neurol Neurosurg Psychiatry 1977;40(8):748-52.
  3. Cengiz, N., Uslu, Y., Gok, F., and Anarat, A. Acute renal failure after overdose of colloidal bismuth subcitrate. Pediatr Nephrol 2005;20(9):1355-1358.
  4. Masannat Y, Nazer E. Pepto bismuth associated neurotoxicity: A rare side effect of a commonly used medication. W V Med J 2013;109(3):32-4.
  5. Halani S, Wu PE. Salicylate toxicity from chronic bismuth subsalicylate use. BMJ Case Rep 2020;13(11):e236929.
  6. Tsay FW, Wu DC, Yu HC, et al. A randomized controlled trial shows that both 14-day hybrid and bismuth quadruple therapies cure most patients with Helicobacter pylori infection in populations with moderate antibiotic resistance. Antimicrob Agents Chemother
  7. De Francesco V, Pontone S, Bellesia A, et al. Quadruple, sequential, and concomitant first-line therapies for H. pylori eradication: a prospective, randomized study. Dig Liver Dis 2018;50(2):139-41.
  8. Wu TS, Hsu PI, Kuo CH, et al. Comparison of 10-day levofloxacin bismuth-based quadruple therapy and levofloxacin-based triple therapy for Helicobacter pylori. J Dig Dis 2017;18(9):537-42.
  9. Liou JM, Fang YJ, Chen CC, Taiwan Gastrointestinal Disease and Helicobacter Consortium. Concomitant, bismuth quadruple, and 14-day triple therapy in the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. Lancet 2016;
  10. Ford AC, Malfertheiner P, Giguere M, et al. Adverse events with bismuth salts for Helicobacter pylori eradication: systematic review and meta-analysis. World J Gastroenterol 2008;14(48):7361-70.
Constipation Gastrointestinal

Orally, bismuth that is not absorbed is excreted in the feces as insoluble salts and may cause stools to appear grayish black. Also, bismuth may cause the tongue to turn black due to macular lingual pigmentation. Other side effects of bismuth therapy, typically when used in combination with other medications including antibiotics and proton-pump inhibitors (PPIs), include abdominal pain, constipation, chronic gastritis, diarrhea, nausea, vomiting, dry mouth, and intestinal metaplasia. However, when compared against non-bismuth containing regimens for Helicobacter pylori infection, the use of bismuth did not increase the risk of abdominal pain, nausea, vomiting, or diarrhea.

  1. Cengiz, N., Uslu, Y., Gok, F., and Anarat, A. Acute renal failure after overdose of colloidal bismuth subcitrate. Pediatr Nephrol 2005;20(9):1355-1358.
  2. DuPont, H. L., Ericsson, C. D., Johnson, P. C., Bitsura, J. A., DuPont, M. W., and de la Cabada, F. J. Prevention of travelers' diarrhea by the tablet formulation of bismuth subsalicylate. JAMA 1987;257(10):1347-1350.
  3. Ford AC, Malfertheiner P, Giguere M, et al. Adverse events with bismuth salts for Helicobacter pylori eradication: systematic review and meta-analysis. World J Gastroenterol 2008;14(48):7361-70.
  4. Zaveri H, Surve A, Cottam D, et al. Does bismuth subgallate affect smell and stool Character? A randomized double-blinded placebo-controlled trial of bismuth subgallate on loop duodenal switch patients with complaints of smelly stools and diarrhea. Obes S
  5. Cohen PR. Black tongue secondary to bismuth subsalicylate: case report and review of exogenous causes of macular lingual pigmentation. J Drugs Dermatol 2009;8(12):1132-5.
  6. Ioffreda MD, Gordon CA, Adams DR, Naides SJ, Miller JJ. Black tongue. Arch Dermatol 2001;137(7):968-9.
  7. Hoffman, J. S., Katz, L. M., and Cave, D. R. Efficacy of a 1-week regimen of ranitidine bismuth citrate in combination with metronidazole and clarithromycin for Helicobacter pylori eradication. Aliment Pharmacol Ther 1999;13(4):503-506.
  8. Scott, B. B. Bismuth-containing single-antibiotic 1-week triple therapy for Helicobacter pylori eradication. Aliment Pharmacol Ther 1998;12(3):277-279.
  9. Sontag, S. J., O'Connell, S., Schnell, T., Chejfec, G., Seidel, J., and Sonnenberg, A. Reduced symptoms and need for antisecretory therapy in veterans 3 years after Helicobacter pylori eradication with ranitidine bismuth citrate/amoxicillin/clarithromycin
  10. Chey, W. D., Fisher, L., Elta, G. H., Barnett, J. L., Nostrant, T., DelValle, J., Hasler, W. L., and Scheiman, J. M. Bismuth subsalicylate instead of metronidazole with lansoprazole and clarithromycin for Helicobacter pylori infection: a randomized trial.
  11. Kaviani, M. J., Malekzadeh, R., Vahedi, H., Sotoudeh, M., Kamalian, N., Amini, M., and Massarrat, S. Various durations of a standard regimen (amoxycillin, metronidazole, colloidal bismuth sub-citrate for 2 weeks or with additional ranitidine for 1 or 2 we
  12. Gisbert, J. P., Marcos, S., Gisbert, J. L., and Pajares, J. M. High efficacy of ranitidine bismuth citrate, amoxicillin, clarithromycin and metronidazole twice daily for only five days in Helicobacter pylori Eradication. Helicobacter 2001;6(2):157-162.
  13. Nijevitch, A. A., Farztdinov, K. M., Sataev, V. U., Khasanov, R. Sh., Katayev, V. A., Khusnutdinov, S. M., Akhunov, E. D., and Kazykhanov, N. S. Helicobacter pylori infection in childhood: results of management with ranitidine bismuth citrate plus amoxici
  14. Bujanda, L., Sanchez, A., Iriondo, C., Santos, A., Cosme, A., and Munoz, C. [Comparative study of the eradication of Helicobacter pylori: ranitidine bismuth citrate versus omeprazole plus two antibiotics for seven days]. An Med Interna 2001;18(7):361-363.
  15. Wilhelmsen, I., Weberg, R., Berstad, K., Hausken, T., Hundal, O., and Berstad, A. Helicobacter pylori eradication with bismuth subnitrate, oxytetracycline and metronidazole in patients with peptic ulcer disease. Hepatogastroenterology 1994;41(1):43-47.
  16. Pozzato, P., Zagari, M., Cardelli, A., Catalano, F. A., Giglio, A., Lami, F., Pilotto, A., Scarpulla, G., Spadaccini, A., Susi, D., Tosatto, R., Olivieri, A., Bazzoli, F., and Roda, E. Ranitidine bismuth citrate plus clarithromycin 7-day regimen is effect
  17. Araujo Castillo, R., Pinto Valdivia, J. L., Ramirez, D., Cok Garcia, J., and Bussalleu Rivera, A. [New ultrashort scheme for helicobacter pylori infection eradication using tetracyline, furazolidone and colloidal bismuth subcitrate in dyspeptic patients w
  18. Bianchi Porro, G., Lazzaroni, M., and Cortvriendt, W. R. Maintenance therapy with colloidal bismuth subcitrate in duodenal ulcer disease. Digestion 1987;37 Suppl 2:47-52.
  19. Johnson, P. C., Ericsson, C. D., DuPont, H. L., Morgan, D. R., Bitsura, J. A., and Wood, L. V. Comparison of loperamide with bismuth subsalicylate for the treatment of acute travelers' diarrhea. JAMA 1986;255(6):757-760.
  20. Shavakhi A, Tabesh E, Yaghoutkar A, Hashemi H, Tabesh F, Khodadoostan M,Minakari M, Shavakhi S, Gholamrezaei A. The effects of multistrain probiotic compound on bismuth-containing quadruple therapy for Helicobacter pylori infection: a randomized placebo-c
  21. Tsay FW, Wu DC, Yu HC, et al. A randomized controlled trial shows that both 14-day hybrid and bismuth quadruple therapies cure most patients with Helicobacter pylori infection in populations with moderate antibiotic resistance. Antimicrob Agents Chemother
  22. De Francesco V, Pontone S, Bellesia A, et al. Quadruple, sequential, and concomitant first-line therapies for H. pylori eradication: a prospective, randomized study. Dig Liver Dis 2018;50(2):139-41.
  23. Wu TS, Hsu PI, Kuo CH, et al. Comparison of 10-day levofloxacin bismuth-based quadruple therapy and levofloxacin-based triple therapy for Helicobacter pylori. J Dig Dis 2017;18(9):537-42.
  24. Liou JM, Fang YJ, Chen CC, Taiwan Gastrointestinal Disease and Helicobacter Consortium. Concomitant, bismuth quadruple, and 14-day triple therapy in the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. Lancet 2016;
Myasthenia gravis Renal

Orally, cases of nephrotoxicity or acute kidney failure resulting from short-term exposure to high levels of bismuth salts, including colloidal bismuth subcitrate (De-Nol) and bismuth sodium triglycollamate (Bistrimate), have been reported. In one case, an adolescent experienced acute kidney failure, characterized by nausea, vomiting, and facial paresthesia, after consuming colloidal bismuth subcitrate (De-Nol) 18 grams in a single dose. Although the patient underwent gastric lavage within 6 hours of ingesting the bismuth salt, multiple incidences of vomiting continued to occur daily for 9 days thereafter. The patient recovered after receiving the metal chelating agent penicillamine 20 mg/kg daily and undergoing hemodialysis therapy every other day or twice weekly until serum creatinine levels reached 2.1 mg/dL. In another case, an adolescent experienced vomiting, tiredness, weakness, and elevated blood urea nitrogen (BUN) after ingesting bismuth sodium triglycollamate (Bistrimate) containing elemental bismuth 75 mg over a few hours. Recovery from kidney failure may take weeks to months.

  1. Cengiz, N., Uslu, Y., Gok, F., and Anarat, A. Acute renal failure after overdose of colloidal bismuth subcitrate. Pediatr Nephrol 2005;20(9):1355-1358.
  2. James JA. Acute renal failure due to a bismuth preparation. Calif Med 1968;109(4):317-9.
DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

Adverse-effects data: Natural Medicines, Therapeutic Research Center

Dosing

There is no single "supplement" dose of bismuth. The right amount depends on the specific product and the reason for use. Always follow the directions on the package label for the product you have, and do not exceed the maximum daily amount listed.

For medical uses such as H. pylori treatment, dosing is set by a doctor as part of a multi-drug regimen. Do not use bismuth products for more than a couple of days for diarrhea without checking with a healthcare provider. If you are unsure how much to take or how long to use it, ask your pharmacist or doctor.

Pregnancy & Breastfeeding

Bismuth & Pregnancy

Insufficient reliable information

Insufficient reliable information available; avoid using.

Bismuth & Breastfeeding

Insufficient reliable information

Insufficient reliable information available; avoid using.

DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

© 2026 Therapeutic Research Center

Pregnancy & lactation ratings: Natural Medicines, Therapeutic Research Center

References & further reading

The 36 references that drive our Bismuth monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. Cengiz, N., Uslu, Y., Gok, F., and Anarat, A. Acute renal failure after overdose of colloidal bismuth subcitrate. Pediatr Nephrol 2005;20(9):1355-1358. PubMed
  2. Callanan, V., Curran, A. J., Smyth, D. A., and Gormley, P. K. The influence of bismuth subgallate and adrenaline paste upon operating time and operative blood loss in tonsillectomy. J Laryngol Otol 1995;109(3):206-208. PubMed
  3. Mishkin, S. Intriguing gastrointestinal properties of bismuth: a folk remedy brought into the realm of clinical and investigative medicine. Can J Gastroenterol 1998;12(8):569-570. PubMed
  4. GOELTNER, E. [Versenate treatment of alopecia following bismuth therapy]. Z Haut Geschlechtskr 1961;31:164-169.
  5. Hoffman, J. S., Katz, L. M., and Cave, D. R. Efficacy of a 1-week regimen of ranitidine bismuth citrate in combination with metronidazole and clarithromycin for Helicobacter pylori eradication. Aliment Pharmacol Ther 1999;13(4):503-506.
  6. Scott, B. B. Bismuth-containing single-antibiotic 1-week triple therapy for Helicobacter pylori eradication. Aliment Pharmacol Ther 1998;12(3):277-279.
  7. Sontag, S. J., O'Connell, S., Schnell, T., Chejfec, G., Seidel, J., and Sonnenberg, A. Reduced symptoms and need for antisecretory therapy in veterans 3 years after Helicobacter pylori eradication with ranitidine bismuth citrate/amoxicillin/clarithromycin PubMed
  8. Chey, W. D., Fisher, L., Elta, G. H., Barnett, J. L., Nostrant, T., DelValle, J., Hasler, W. L., and Scheiman, J. M. Bismuth subsalicylate instead of metronidazole with lansoprazole and clarithromycin for Helicobacter pylori infection: a randomized trial.
  9. Kaviani, M. J., Malekzadeh, R., Vahedi, H., Sotoudeh, M., Kamalian, N., Amini, M., and Massarrat, S. Various durations of a standard regimen (amoxycillin, metronidazole, colloidal bismuth sub-citrate for 2 weeks or with additional ranitidine for 1 or 2 we
  10. Gisbert, J. P., Marcos, S., Gisbert, J. L., and Pajares, J. M. High efficacy of ranitidine bismuth citrate, amoxicillin, clarithromycin and metronidazole twice daily for only five days in Helicobacter pylori Eradication. Helicobacter 2001;6(2):157-162.
  11. Nijevitch, A. A., Farztdinov, K. M., Sataev, V. U., Khasanov, R. Sh., Katayev, V. A., Khusnutdinov, S. M., Akhunov, E. D., and Kazykhanov, N. S. Helicobacter pylori infection in childhood: results of management with ranitidine bismuth citrate plus amoxici
  12. Bujanda, L., Sanchez, A., Iriondo, C., Santos, A., Cosme, A., and Munoz, C. [Comparative study of the eradication of Helicobacter pylori: ranitidine bismuth citrate versus omeprazole plus two antibiotics for seven days]. An Med Interna 2001;18(7):361-363.
  13. Wilhelmsen, I., Weberg, R., Berstad, K., Hausken, T., Hundal, O., and Berstad, A. Helicobacter pylori eradication with bismuth subnitrate, oxytetracycline and metronidazole in patients with peptic ulcer disease. Hepatogastroenterology 1994;41(1):43-47.
  14. DuPont, H. L., Ericsson, C. D., Johnson, P. C., Bitsura, J. A., DuPont, M. W., and de la Cabada, F. J. Prevention of travelers' diarrhea by the tablet formulation of bismuth subsalicylate. JAMA 1987;257(10):1347-1350. DOI
  15. Pozzato, P., Zagari, M., Cardelli, A., Catalano, F. A., Giglio, A., Lami, F., Pilotto, A., Scarpulla, G., Spadaccini, A., Susi, D., Tosatto, R., Olivieri, A., Bazzoli, F., and Roda, E. Ranitidine bismuth citrate plus clarithromycin 7-day regimen is effect
Keep reading

This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Brand directory

Brands that make products with Bismuth

29 brands in our database make a supplement containing Bismuth.

Product directory

Supplement products with Bismuth

67 products in our database contain Bismuth. Open any to see its full ingredient list and every drug interaction we check.

21 Multi by Somaplex Liquid 3.38 fl. Oz. · 100 mL View ingredients & interactions Advanced Multiple by BodSmith Liquid 1 Quart(s) · 32 Fluid Ounce(s) · 946 mL View ingredients & interactions AloeAminos Power Nutrition by Dr. LaMar's Products Liquid 128 Fluid Ounce(s) · 3628.74 Gram(s) View ingredients & interactions Bismuth by Oligocan Liquid 100 mL View ingredients & interactions Cal-Mag+ by MBi Nutraceuticals Liquid 12 Oz(s) View ingredients & interactions Complete Multiple Natural Berry Flavor by Liquid Health Liquid 32 fl. Oz. · 946 mL View ingredients & interactions Creation Mineral Boost by Dr. LaMar's Products Liquid 32 Fluid Ounce · 907.18 Gram(s) View ingredients & interactions Fulvic Trace Minerals by Good State Liquid 16.2 Fluid Ounce(s) · 480 mL View ingredients & interactions GastroMycin with Bismuth Salts by NutriCology Capsule 150 Vegetarian Capsule(s) View ingredients & interactions GastroMycin with Bismuth Salts by Allergy Research Group Capsule 150 Vegetarian Capsule(s) View ingredients & interactions GastroMycin with Bismuth Salts by NutriCology Capsule 150 Vegetarian Capsule(s) View ingredients & interactions GastroMycin with Bismuth Salts by Allergy Research Group Capsule 150 Vegetarian Capsule(s) View ingredients & interactions Grape Colloidal Minerals by Buried Treasure Liquid Nutrients Liquid 32 Fluid Ounce(s) · 946 mL View ingredients & interactions Immune Shield by Sunwarrior Powder 600 mL · 20.3 fl. Oz. · 40 Packet(s) View ingredients & interactions Immune Shield Silver + Gold by Sunwarrior Powder 15 mL View ingredients & interactions intraKID All-In-One All Natural Raspberry Flavor by Drucker Labs Liquid 33 fl. Oz. · 975.93 mL View ingredients & interactions intraMIN Organic Trace Minerals Tropical Fruit Flavor by Drucker Labs Liquid 32 fl. Oz. · 946 mL View ingredients & interactions intraMIN Organic Trace Minerals Unflavored by Drucker Labs Liquid 32 fl. Oz. · 946 mL View ingredients & interactions Ionic Fulvic Trace by Good State Liquid 16.2 fl. Oz. · 480 mL View ingredients & interactions Ionized Trace Minerals by Tropical Oasis Liquid 16 Fluid Ounce(s) · 480 mL View ingredients & interactions Liquid Colloidal Minerals by Healthy Natural Systems Liquid 32 fl. Oz. · 1 QT · 946 mL View ingredients & interactions Liquid Vitamin Mineral Rush by Sunwarrior Liquid 236.5 mL · 8 fl. Oz. View ingredients & interactions Mega Multiple Vitamin Mineral Tropical Plus by Tropical Oasis Liquid 32 Fluid Ounce(s) · 960 mL View ingredients & interactions Men's Mega Multi-Vitamin by Tropical Oasis Liquid 32 Fluid Ounce(s) · 960 mL View ingredients & interactions
Pharmacist Counseling Corner

Bismuth: Common Questions

What is Bismuth used for, and does it work?
People use Bismuth for many reasons, but the evidence varies by use. According to the Natural Medicines database, there is at least some clinical evidence supporting Bismuth for Travelers' diarrhea, Helicobacter pylori and Peptic ulcers. For most other uses it has been studied for, the evidence is currently insufficient to rate. See the graded list on this page, and always confirm with your pharmacist or doctor.
Does Bismuth interact with prescription medications?
Yes. We list 125 medications with a known interaction with Bismuth. Use the checker above to see how Bismuth interacts with a specific drug.
How are Bismuth interactions rated?
Each interaction is graded major, moderate, or minor based on how clinically significant it is and the strength of the evidence behind it. Major interactions are the most serious and are best avoided, or used only under close professional supervision.
Is it safe to take Bismuth with my medications?
It depends on the specific medication. Some combinations are fine, while others call for monitoring, timing changes, or should be avoided. Check your exact drug above and confirm with your pharmacist or doctor before starting, stopping, or changing anything.
Where does this Bismuth interaction information come from?
Our interaction data is built on the Natural Medicines database — an evidence-graded reference for vitamins, herbs, and supplements — and is reviewed by licensed HelloPharmacist pharmacists, who may add clinical context.
What is Bismuth used for?
It is used mostly as Bismuth subsalicylate to relieve upset stomach, heartburn, nausea, indigestion, and diarrhea, and it can be part of doctor-prescribed treatment for H. pylori stomach infections.
Why did Bismuth turn my tongue or stool black?
This is a common and harmless reaction caused by the Bismuth reacting with small amounts of sulfur in your mouth and gut. It goes away after you stop taking the product.
Can children take Bismuth?
Be very careful. Bismuth subsalicylate contains a salicylate (aspirin-like compound), which should not be given to children or teens recovering from flu or chickenpox because of the risk of Reye's syndrome. Ask a pediatrician first.
Is it safe to take Bismuth every day?
Bismuth is intended for short-term use. Taking it daily for long periods can raise the risk of side effects, so check with your pharmacist or doctor before using it regularly.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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Products that contain Bismuth

A rotating sample of real supplements in our database that list Bismuth — open any to see its full ingredients and every drug interaction we check.

See all 67 products with Bismuth →
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