Tripotassium dicitratobismuthate

TRIPOTASSIUM DICITRATOBISMUTHATE ANTIBIOTICS-TETRACYCUNES -l levels of tetracyclines 1 absorption of tetracyclines Separate doses by 2-3 hours 

TRIPOTASSIUM DICITRATOBISMUTHATE H2 RECEPTOR BLOCKERS-RANITIDINE t adverse effects of tripotassium dicitratobismuthate T absorption Do not use together for more than 16 weeks. Bismuth salicylate and subnitrate do not interact 

DRUGS ACTING ON THE GASTROINTESTINAL TRACT TRIPOTASSIUM DICITRATOBISMUTHATE 

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Tripotassium dicitratobismuthate [57644-54-9] (bismuth subcitrate), De-Nol is a buffered aqueous suspension of a poorly defined, water-insoluble bismuth compound. It is said to very effective for the treatment of gastric and duodenal ulcers (180,184). There have not yet been any reports of bismuth encephalopathy following the use of this dmg. 

Tripolyphosphates, 18 844-846 Tripotassium dicitratobismuthate, 4 36 Tripotassium hexakiscyanoferrate, 14 535 Tripotassium phosphate (TKP), 18 834 2,4,6-Tripropyl-l,3,5-trioxane butyraldehyde derivative, 4 461 cis-Tripropenylbismuth dibromide, 4 31-32... 

Milk and dairy foods decrease the absorption of some tetracyclines (doxycycline and minocycline are not affected), some quinolone antibiotics (absorption of ciprofloxacin and norfloxacin is decreased but ofloxacin is not affected), penicillamine and alendronate. Large volumes of milk can reduce the ulcer-healing properties of bismuth tripotassium dicitratobismuthate (bismuth chelate),... 

Tripotassium dicitratobismuthate, bismuth subcitrate, (De-Nol) This substance was originally thought to act mainly by chelating with protein in the ulcer base to form a coating, which protects the ulcer from the adverse influences of acid, pepsin and bile. Subsequently, bismuth chelate was found to possess an additional valuable action, namely activity against Helicobacter pylori, especially when combined with an antimicrobial (see below). 

Bismuth-containing antacid preparations have been in use for a long time, but some of the bismuth chelates (e.g. tripotassium dicitratobismuthate) are of proven benefit in ulcer, and, though it is not clear how they work, there is some... 

The pharmacokinetics of lomoxicam, meloxicam, piroxicam and tenoxicam were not affected by aluminium/magnesium hydroxide antacids. Lomoxicam pharmacokinetics were also not altered by tripotassium dicitratobismuthate or aluminium hydroxide with calcium carbonate. 

Neither 10 mL of Maalox (aluminium/magnesium hydroxide) nor 10 g of Solugastril (aluminium hydroxide with calcium carbonate) had any effect on the pharmacokinetics of a 4-mg lomoxicam film-coated tablet in 18 healthy fasted subjects. A later study similarly found no changes in the absorption or pharmacokinetics of a lomoxicam film-coated tablet given with bismuth chelate (tripotassium dicitratobismuthate) 120 mg twice daily. There would seem to be no reason for avoiding concurrent use. 

Bismuth compounds Bismuth biskalcitrate. Bismuth salicylate. Bismuth subnitrate. Tripotassium dicitratobismuthate... 

Ranitidine possibly causes an increase in the absorption of bismuth from tripotassium dicitratobismuthate, but not bismuth salicylate or bismuth subnitrate. Any increase is considered unlikely to be clinically relevant with recommended short courses for H. pylori eradication. Other H2-receptor antagonists would be expected to interact similarly. 

The AUC of a single 240-mg dose of tripotassium dicitratobismuthate (TDB, De Noltabs), was increased fourfold in 12 healthy subjects given two 300-mg doses of ranitidine (one the night before and one 2 hours before the bismuth compound). The maximum serum levels were approximately doubled. The same regimen of ranitidine had no significant effect on the absorption of bismuth from bismuth salicylate (Pepto-Bismol) or bismuth subnitrate (Roter tablets) ... 

Omeprazole markedly increases the absorption and bioavailability of bismuth from tripotassium dicitratobismuthate and bismuth biskalcitrate. Other proton pump inhibitors are expected to interact similarly. However, this is probably unlikely to be clinically relevant. 

In an earlier single-dose study in 6 healthy subjects, a single 240-mg dose of tripotassium dicitratobismuthate was taken 1 hour after the last dose of a 1-week course of omeprazole 40 mg daily. Omeprazole increased the AUC of bismuth fourfold, and increased the maximum serum levels from 36.7 to 86.7 micrograms/L, which the authors pointed out approaches the considered toxic range for bismuth (100 micrograms/L and above). 

Bismuth salts were used in the eighteenth and nineteenth centuries as antimicrobial compounds and also as antacids. With the discovery that Helicobacter pylori was the causative agent of ulcer formation, there was revival of interest in their use in the 1990s. The most commonly used water-soluble form of bismuth is tripotassium dicitratobismuthate... 

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