Does bismuth subsalicylate interact with sertraline? (1+ risks)
By
Ivan Kahwa
| Reviewed by
Ivan Kahwa
The contents of this article are fact-based except otherwise stated within the article.
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Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
Reviewer bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss whether bismuth subsalicylate interacts with sertraline – an antidepressant. We will also discuss some research studies and the potential risks of combining these medications. We will also discuss some safer alternatives.
Does bismuth subsalicylate interact with sertraline?
Bismuth subsalicylate can interact with sertraline and cause side effects in certain individuals. Bismuth subsalicylate, an active ingredient in Pepto-Bismol, is commonly used for indigestion and related symptoms. It is available over the counter, and some people might pair it with sertraline, an antidepressant (1,2).
Although these medications do not interact pharmacokinetically – meaning bismuth subsalicylate does not interfere with the metabolism of sertraline or how it works. However, both of these medications can cause blood thinning to some extent.
Taking them concomitantly, especially in cases with pre-existing haematological disorders, can increase the risk of bleeding. It’s best to consult your provider before pairing these two meds together if you have other comorbidities or a bleeding disorder.
What does research suggest?
There is limited research on the potential interactions between bismuth subsalicylate and sertraline. However, research does indicate that bismuth subsalicylate converts into salicylic acid or salicylate, which can cause blood thinning (3).
Aspirin, a common blood thinner, is also a salicylic acid called acetylsalicylic acid. These substances cause blood thinning and can increase the risk of bleeding when taken chronically (4).
On the other hand, research also suggests that sertraline has mild blood-thinning properties that can be more pronounced if higher doses are consumed (5). This indicates that both of these medications can thin blood, and taking them concomitantly can cause side effects in susceptible individuals.
What are the potential risks of taking bismuth subsalicylate with sertraline?
The potential risks of taking bismuth subsalicylate with sertraline include:
Gastrointestinal side effects
Both bismuth subsalicylate and sertraline are known to cause gastrointestinal side effects independently. Combining them may increase the severity of these side effects. Bismuth subsalicylate, in particular, can convert into salicylic acid in the stomach, contributing to additional gastrointestinal discomfort.
Increased risk of gastrointestinal bleeding
The combination of bismuth subsalicylate and sertraline raises the risk of gastrointestinal bleeding. Salicylates, like those produced by bismuth subsalicylate, are associated with blood-thinning effects.
When combined with sertraline, which also has blood-thinning properties, there is an increased potential for bleeding issues, especially in the gastrointestinal tract.
What factors can influence bismuth subsalicylate-sertraline interaction?
Several factors can influence bismuth subsalicylate-sertraline interaction, including:
Dosage and frequency
The risk of adverse effects, particularly bleeding complications, may increase with higher doses and more frequent administration of bismuth subsalicylate and sertraline together.
Underlying health conditions
Individuals with pre-existing bleeding disorders are at a higher risk of experiencing complications when combining bismuth subsalicylate and sertraline.
Use of other medications
Concurrent use of medications with bismuth subsalicylate and sertraline that also have blood-thinning properties, such as anticoagulants or non-steroidal anti-inflammatory drugs (NSAIDs), can further increase the risk of bleeding.
Genetic factors
Genetic variations can contribute to individual responses to medication combinations. Some people may not respond well to the use of bismuth subsalicylate and sertraline together.
What are the alternatives to bismuth subsalicylate while taking sertraline?
These are some alternatives to bismuth subsalicylate that you can take while taking sertraline:
Loperamide (Imodium):
Loperamide is an OTC antidiarrheal medication that helps relieve symptoms of diarrhoea. It works by slowing down the movement of the intestines, providing relief without significant interactions with sertraline. (6)
Acid reducers
Some acid reducers, like proton pump inhibitors including Omeprazole and H2 receptors like famotidine, can be taken while taking sertraline if you are struggling with acid reflux. (7)
Heartburn or increased stomach acidity could be sertraline induced and your diet can help you a great deal here. Make sure you avoid spicy and greasy foods or anything that triggers an episode of acid reflux.
Simethicone
Simethicone is an OTC medication used to relieve symptoms of excess gas (8). It works by helping gas bubbles come together, making it easier for the body to eliminate them. Simethicone typically does not interact with sertraline.
As a pharmacist, I always advise checking for drug-drug interactions before you take any medication, even an over-the-counter one, with your antidepressant.
Although healthy individuals may not feel a difference after combining bismuth subsalicylate and sertraline, some people could experience side effects or be susceptible to this interaction.
So, it’s best to discuss medication for common ailments with your doctor when you’re being treated with an antidepressant. This ensures the safe and effective use of multiple medications together and prevents any potential interaction between them.
References
- Budisak P, Abbas M. Bismuth Subsalicylate. 2023 Jun 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32809532. https://www.ncbi.nlm.nih.gov/books/NBK560697
- Singh HK, Saadabadi A. Sertraline. 2023 Feb 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31613469. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547689
- Roncaglioni MC, Reyers I, Cerletti C, Donati MB, de Gaetano G. Moderate anticoagulation by salicylate prevents thrombosis without bleeding complications. An experimental study in rats. Biochem Pharmacol. 1988 Dec 15;37(24):4743-5. doi: 10.1016/0006-2952(88)90346-2. PMID: 3202906. https://pubmed.ncbi.nlm.nih.gov/3202906/
- Buchanan MR, Hirsh J. Effect of aspirin on hemostasis and thrombosis. N Engl Reg Allergy Proc. 1986 Jan-Feb;7(1):26-31. doi: 10.2500/108854186779045539. PMID: 3302653. https://pubmed.ncbi.nlm.nih.gov/3302653/
- Eslami Shahrbabki M, Eslami Shahrbabaki A. Sertraline-related bleeding tendency: could it be dose-dependent? Iran J Psychiatry Behav Sci. 2014 Fall;8(3):81-3. PMID: 25780379; PMCID: PMC4359729. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4359729/
- Sahi N, Nguyen R, Santos C. Loperamide. 2023 Mar 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32491808. https://www.ncbi.nlm.nih.gov/books/NBK557885
- Takahashi Y, Amano Y, Yuki T, Ose T, Miyake T, Kushiyama Y, Sato S, Ishihara S, Kinoshita Y. Influence of acid suppressants on gastric emptying: cross-over analysis in healthy volunteers. J Gastroenterol Hepatol. 2006 Nov;21(11):1664-8. doi: 10.1111/j.1440-1746.2006.04270.x. PMID: 16984586. https://pubmed.ncbi.nlm.nih.gov/16984586/
- Ingold CJ, Akhondi H. Simethicone. 2023 Jul 3. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32310457. https://www.ncbi.nlm.nih.gov/books/NBK555997
