Pharmacokinetics of Bismuth Compounds in Patients with Gastritis and Ulcer Disease During Standard Treatment

Abstract

Since Helicobacter pylori was identified as an important factor in the pathogenesis of gastritis and ulcer disease, bismuth compounds have been widely used in the treatment of these diseases. The bismuth compounds at present on the market comprise subcitrate, subsalicylate, nitrate, gallate, and aluminate salts. After oral ingestion of these preparations, bismuth is partly absorbed from the intestine. Encephalopathy has been reported as one of several side effects of bismuth therapy in patients using large doses of bismuth preparations. In these patients, bismuth concentrations exceeding 100 µg/1 have been measured. From these findings, the recommendations were derived that bismuth treatment should be stopped if bismuth levels rise above 100 µg/1 [1]. Recently, peak bismuth concentrations in plasma exceeding 100 µg/1 have been reported in patients and healthy subjects after oral ingestion of standard doses of tripotassium dicitratobismuthate [2,3]. In the present study, we investigated the pharmacokinetics of the widely used compound bismuth subsalicylate and compared it with bismuth subcitrate.