Bismuth Subsalicylate

Also indexed as: Bismatrol®, BSS, Pepto-Bismol®

Combination drugs: Bisma-Rex®, Helidac®, Moorland®, Roter®

Bismuth subsalicylate is a nonprescription drug used to relieve indigestion without constipation, nausea, and abdominal cramps. It is also used to control diarrhea and traveler’s diarrhea. Bismuth subsalicylate is used together with prescription antibiotics and stomach acid-blocking drugs to treat gastric and duodenal ulcers associated with Helicobacter pylori infection.

Safetychecker Summary for Bismuth Subsalicylate
(for details about the summarized interactions, read the full article)

Avoid Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.

Salicylate-containing herbs* such as meadowsweet, poplar, willow, and wintergreen

Sarsaparilla
Depletion or interference

None known
Side effect reduction/prevention

None known
Supportive interaction

None known
Reduced drug absorption/bioavailability

None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Herbs

Sarsaparilla  (Smilax spp.)
Sarsaparilla may increase the absorption of digitalis and bismuth, increasing the chance of toxicity.1

Salicylate-containing herbs
Bismuth subsalicylate contains salicylates. Various herbs including meadowsweet (Filipendula ulmaria), poplar (Populus tremuloides), willow (Salix alba), and wintergreen (Gaultheria procumbens) contain salicylates as well. Though similar to aspirin, plant salicylates have been shown to have different actions in test tube studies.2 Furthermore, salicylates are poorly absorbed and likely do not build up to levels sufficient to cause negative interactions that aspirin might.3 No reports have been published of negative interactions between salicylate-containing plants and aspirin or aspirin-containing drugs.4 Therefore concerns about combining salicylate-containing herbs remain theoretical, and the risk of causing problems appears to be low.

References:

1. Bradley PR (ed). British Herbal Compendium, vol 1. Bournemouth, Dorset, UK: British Herbal Medicine Association, 1992, 194–6.

2. Wichtl M, Bisset NG, eds. Herbal Drugs and Phytopharmaceuticals. Stuttgart: Medpharm GmBH Scientific Publishers.

3. Janssen PL, Katan MB, van Staveren WA, et al. Acetylsalicylate and salicylates in foods. Cancer Lett 1997:114(1–2):163–4.

4. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. (1997) American Herbal Product Association’s Botanical Safety Handbook. Boca Raton, FL: CRC Press, 1997, 154–5.