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Review

Bismuth

No authors listed
In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012.
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Review

Bismuth

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Excerpt

Bismuth is a brittle, silvery-white metal that is used in paints, cosmetics, electronics, and a few over-the-counter pharmaceuticals, usually as bismuth subsalicylate or subcitrate, primarily to treat diarrhea and digestive disorders. Currently, the major medical use of bismuth is as a component of quadruple therapy of Helicobacter pylori infection. There is scant evidence that bismuth, even in high doses, causes serum aminotransferase elevations or clinically apparent liver injury.

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References

    1. Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999.(Review of hepatotoxicity published in 1999; bismuth is not discussed).
    1. Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier, 2013.(Textbook on hepatotoxicity; bismuth is not discussed).
    1. Byrns MC, Penning TM. Treatment of metal exposure. Environmental toxicology: carcinogens and heavy metals. In, Brunton LL, Hilal-Dandan R, Knollman BC, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 13th ed. New York: McGraw-Hill, 2018, pp. 1311-5.(Textbook of pharmacology and therapeutics).
    1. Stokes JH, Ruedemann R, Lemon WS. Epidemic infectious jaundice and its relation to the therapy of syphilis. Arch Intern Med 1920; 26: 521-543. Not in PubMed.(Between 1916 and 1920, there were 70 cases of jaundice arising during arsphenamine therapy of syphilis at the Mayo Clinic, but the frequency increased markedly during that time [1000-fold] suggesting an epidemic of hepatitis rather than hepatitis from therapy, an idea which was also supported by a lack of uniform latency to onset after starting therapy and lack of recurrence when therapy was resumed as well as the similarity of symptoms [particularly prodromal symptoms of fever, arthritis, and rash], laboratory tests, and timing between jaundice in epidemics occurring concurrently in Minnesota).
    1. Nomland R, Skolnik EA, McLellan LL. Jaundice from bismuth compounds used in the therapy of syphilis. JAMA 1938; 11; 19-21. Not in PubMed.(Among 75 cases of jaundice occurring during therapy of syphilis, 32 were attributed to bismuth subsalicylate, after 11 to more than 30 injections, beginning within 6 weeks of the last dose, ten having received bismuth only, the remainder also receiving arsphenamine. The authors state that the injury is indistinguishable from “catarrhal jaundice” [acute viral hepatitis] and in several cases bismuth was restarted without recurrence of jaundice, factors that suggest that the injury was due to acute hepatitis B or C transmitted by inadequately sterilized reusable syringes or needles).

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