Ranitidine Bismuth subcitrate

CBS = colloidal bismuth subcitrate RBC = ranitidine bismuth citrate approximate formulas. 

Bismuth-containing preparations (e.g., those containing colloidal bismuth subcitrate) have effects similar to those of sucralfate, apparently because of their similar physical properties and coating effects. A combination of ranitidine-bismuth citrate is used with clarithromycin for eradication of H. pylori in the treatment and prevention of recurrence of duodenal ulcers. Combinations of bismuth subcitrate with other antibiotics and with H2 antihistamines also are used. Bismuth subsalicylate is used in this way as well. 

Interestingly, all of the elements in group 15 in the periodic table (N, P, As, Sb and Bi) are directly or indirectly related to the maintenance of human life as either essential elements (e.g., N and P) or therapeutic/toxic elements (e.g.. As, Sb and Bi). Currently antimony compounds (e.g., sodium stibogluconate, Pentostam ) are used clinically for the treatment of leishmaniasis and bismuth compounds (e.g., bismuth subsalicylate (BSS), colloidal bismuth subcitrate (CBS) and ranitidine bismuth citrate (RBC)) are widely used for the treatment of ulcer and Helicobacter pylori infection [l-3c,10,132,133]. Recently, clinical... 

Scheme 5.7 The basic BP citrate dimer found in the antiulcer drugs, colloidal bismuth subcitrate (CBS, DE-Nol ) and possibly ranitidine bismuth citrate. Assembly of these building block leads to the formation of polymeric anion.

Eradication and acid-suppressive combination therapy with ranitidine and bismuth subcitrate... 

A newer combination of ranitidine and bismuth subcitrate with two antibiotics has also been introduced and approved for eradication. It is claimed that this form of bismuth is more soluble and more available for bactericidal action. However, significant blood levels of bismuth have been detected in some patients, and this cation is neurotoxic and nephrotoxic. Most of the data reported have not used intention-to-treat criteria, and the general impression is that eradication is less effective. Another issue is that after eradication therapy, treatment with ranitidine is continued for the routine period of 8 weeks rather than the 4 weeks for a PPI. 

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