Does bismuth subsalicylate interact with sertraline? (1+ risks)

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 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.


  1. Budisak P, Abbas M. Bismuth Subsalicylate. 2023 Jun 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32809532. 
  1. Singh HK, Saadabadi A. Sertraline. 2023 Feb 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31613469. Available from:
  1. 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. 
  1. 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. 
  1. 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. 
  1. Sahi N, Nguyen R, Santos C. Loperamide. 2023 Mar 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32491808. 
  1. 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. 
  1. Ingold CJ, Akhondi H. Simethicone. 2023 Jul 3. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32310457. 

Was this helpful?

Thanks for your feedback!