Therapeutic properties

How does bismuth act on Helicobacter?

1. Malfertheiner P., Megraud F., O’Morain CA et al. Management of Helicobacter pylori infection the Maastricht V/Florence Consensus Report. Gut 2016 October 5. doi: org/10.1136/gutjnl-2016-312288. 2. Sugano K., Tack J., Kuipers EJ et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut 2015; 64:1353-67. 3. McNicholl AG, Nyssen OP, Bordin DS et al. PanEuropean registry on H. pylori management (HP-EUREG): first-line treatments and interim analysis of 20000 patients. United European Gastroenterology Week. Barcelona; 2018. Oral presentation. 4. Sun Q., Liang X., Zheng Q. et al. High efficacy of 14-day triple therapy-based, bismuth-containing quadruple therapy for Initial Helicobacter pylori eradication. Helicobacter 2010; 15:233-8. 5. Leya M. The epidemiology of H. pylori infection and associated diseases. United European Gastroenterology Week. Postgraduate Teaching Program. Barcelona; 2018. Oral presentation. 6. Alkim H., Koksai AR Boga S. et al. Role of bismuth in the eradication of Helicobacter pylori. Am J Ther 2017; 24(6):751-7. 7. Megraud F. Failed eradication for Helicobacter pylori. What should be done? Dig Dis 2016; 34(5):505-9. 8. Graham DY, Dore MP Helicobacter pylori therapy: a paradigm shift. Expert Re Anti Infect Ther 2016; 14(6):577-86. 9. Mendis AHW, Marshall BJ Helicobacter pylori and Bismuth In: Biological Chemistry of Arsenic, Antimont and Bismuth. Ed. Sun H. Wiley; 2011. P. 241-62. 10. Malferheiner P. Welcome and introduction. Satellite Symposium “What’s new in Helicobacter pylori eradication. The renaissance of bismuth.” EHMSG XXIXth International Workshop. Magdeburg; 2016. Oral presentation. 11. Okovity S.V., Ivkin D.Yu. Bismuth preparations: pharmacological basis of clinical effect. Attending Physician 2015; 10:67-73 [Okovity SV, Ivkin D.Yu. Bismuth drugs – pharmacological basis of clinical efficacy. Lechashchy vrach 2015; 10:67-73]. 12. Marshall BJ Helicibacter Connections, Nobel lecture. In: The Nobel Prizes. Ed. Grandin K. Stockholm; 2006. P. 250-77. 13. Wang Y., Hu L., Xu F. Integrative approach for the analysis of the proteome-wide response to bismuth drugs in Helicobacter pylori. Chem Sci 2017; 8(6):46-26. 14. Li H., Sun H. Recent advances in bioinorganic chemistry of bismuth. Curr Opin Chem Biol 2012; 16:74-83. 15. Chen Z., Zhou Q., Ge R. Inhibition of fumarase by bismuth (III): implications for the tricarboxylic acid cycle as a potential target of bismuth drugs in Helicobacter pylori. Biometals 2012; 25:95-102. 16. Marcus EA, Sachs G., Scott DR Colloidal bismuth subcitrate (CBS) impedes proton entry into Helicobacter pylori and increases the efficacy of growth dependent antibiotics. Aliment Pharmacol Ther 2015; 42(7):922-33. 17. Marcus EA, Sachs G., Scott DR Eradication of Helicobacter pylori infection. Cur Gastroenterol Rep 2018; 18(7):33. 18. Ford AC, Malfertheiner H, Giguere M et al. Adverse events with bismuth salts for Helicobacter pylori eradication: systematic review and meta-analysis. World J Gastroenterol 2008; 15(48):7361-70. 19. Bazzoli F. Update on management of Helicobacter pylori infection and the role of bismuth. Satellite Symposium “What’s new in Helicobacter pylori eradication. The renaissance of bismuth.” EHMSG XXIXth International Workshop. Magdeburg; 2016. Oral presentation. 20. Chey WD, Leonitiadis GI, Howden CW, Moss SF ACG clinical guideline: treatment of Helicobacter pylori Infection. Am J Gastroenterol 2017; 1123:212-38. 21. Dore MP, Lu H., Graham DJ Role of bismuth in improving Helicobacter pylori eradication with triple therapy. Gut 2016; 0: 1-9 doi:10.1136/gutjn-2015-311019. 22. Ivashkin V.T., Maev I.V., Lapina T.L., Sheptulin A.A. and a committee of experts. Recommendations for the diagnosis and treatment of Helicobacter pylori infection in adults. Ros journal gastroenterol hepatol coloproctol 2012; 22(1):87-9. 23. Liao J., Zheng Q., Liang X. et al. Effect of fluoroquinolone resistance on 14-day levofloxacin triple and triple plus bismuth quadruple therapy. Helicobacter 2013; 18:373-7. 24. Zhang W., Chen Q., Liang X. et al. Bismuth, lansoprazole, amoxicillin and metronidazole or clarithromycin as first-line Helicobacter pylori therapy. Gut 2015; 64(11):1715-20. 25. Chen Q., Zhang W., Fu Q. et al. Rescue Therapy for Helicobacter pylori eradication: a randomized noninferiority trial of amoxicillin or tetracycline in bismuth quadruple therapy. Am J Gastroenterol 2016; 111(12): 1736-42. 26. Marušić M., Dominković L., Majstorović Barać K. et. Bismuth-based quadruple therapy modified with moxifloxacin for Helicobacter pylori eradication. Minerca Gastroenterol Dietol 2017; 63(2):80-4. 27. Ivashkin V.T., Maev I.V., Lapina T.L., Sheptulin A.A. Treatment of Helicobacter pylori infection: mainstream and innovations (Literature review and resolution of the Expert Council of the Russian Gastroenterological Association). Ros journal gastroenterol hepatol coloproctol 2017; 27(4):4-21. 28. Kononov A.V., Mozgovoy S.I., Rybkina L.B. and others. Evaluation of the cytoprotective effect of bismuth tripotassium dicitrate on the gastric mucosa during eradication of H. pylori and prolonged use of the drug. Ros journal gastroenterol hepatol coloproctol 2014; 24(6):21-8. 29. Keogan DM, Griffith DM Current and potential applications of bismuth-based drugs. Molecules 2014; 19:15258-97. Numerous studies have proven the pathogenic role of the bacterium Helicobacter pylori in the development of gastritis and peptic ulcers of the stomach and duodenum. Epidemiological studies conducted in many countries of the world, including Russia, have proven the widespread distribution of this microorganism. Today, therapy for peptic ulcer disease is primarily associated with the diagnosis of Helicobacter bacteria. When a pathogen is identified, drugs directed against Helicobacter pylori must be included in the complex treatment regimen. The pharmacist talks about the drug Bismuth tripotassium dicitrate: composition, mechanism of action, indications, contraindications and side effects. Compares the product with its analogue Ulcavis.

Radar station

  • belongs to the pharmacotherapeutic group “Antiulcer, antiseptic intestinal and astringent”;
  • dispensed from pharmacies without a doctor’s prescription;
  • included in the List of Vital and Essential Drugs (vital and essential drugs) of the Russian Federation and the pharmacy Minimum range of drugs.

Composition

The composition of the drug Bismuth tripotassium dicitrate includes the active substance of the same name, which is also contained in other well-known drugs: De-Nol, Escape, Ulcavis. Under the trade name Bismuth tripotassium dicitrate, the product is produced by Russian pharmaceutical companies Avexima, Vertex, Ozon, etc.

Bismuth tripotassium dicitrate is a film-coated tablet containing 120 mg of the active substance in terms of bismuth oxide. The dosage of tablets is the same for all manufacturers.

Mechanism of action

Let’s look at how the substance bismuth tripotassium dicitrate (BTD) acts in the body and answer the question of whether it is an antibiotic or not.

VTD has a pronounced antiulcer, anti-inflammatory and astringent effect, as well as a bactericidal effect against Helicobacter pylori. Once in the stomach, the substance forms a protective film on the surface of ulcers and erosions on the mucous membrane. At the same time, the drug stimulates the production of protective prostaglandin E, which increases mucus secretion and reduces the concentration of hydrochloric acid and pepsin activity. This facilitates the healing of ulcerative lesions.

By nature and structure, VTD is not an antibiotic, but has an antimicrobial effect. It inhibits the activity of enzymes in bacterial cells and destroys their structure. Thus, the drug Bismuth tripotassium dicitrate has a dual mechanism of action: it destroys Helicobacter pylori and restores mucous membranes.

Bismuth tripotassium dicitrate-Vertex: from what?

  • exacerbation of gastric and duodenal ulcers, including those associated with Helicobacter pylori;
  • exacerbation of chronic gastritis and gastroduodenitis, including those associated with Helicobacter pylori;
  • IBS – irritable bowel syndrome;
  • functional dyspepsia not associated with gastrointestinal diseases.

Противопоказания

  • hypersensitivity to any components of the tablets;
  • pregnancy, lactation;
  • taking other bismuth-containing drugs;
  • chronic renal and liver failure;
  • age to 4 years.

Side effects

  • very often: black stool;
  • uncommon: nausea, vomiting, diarrhea or constipation; skin rash, itching;
  • very rarely: anaphylactic reactions; with long-term treatment in high doses – encephalopathy due to the accumulation of bismuth in the central nervous system.

Which is better: Ulcavis or Bismuth tripotassium dicitrate?

Ulcavis is a complete analogue of Bismuth tripotassium dicitrate: they have the same active ingredients, release form, dosage, indications, etc. The average cost of treatment is also at the same level.

The differences between Ulcavis and Bismuth tripotassium dicitrate lie only in the manufacturers of the active substances: for the drug Ulcavis, the Slovenian company KRKA uses raw materials from Germany, and domestic companies from Russia and China. The patient can choose any of them taking into account his own preferences.

Summary

  • According to the Register of Medicines, bismuth tripotassium dicitrate belongs to the pharmacotherapeutic group “Antiulcer, antiseptic intestinal and astringent”.
  • The composition of the medicine Bismuth tripotassium dicitrate includes the active substance of the same name.
  • The drug Bismuth tripotassium dicitrate has a dual mechanism of action: it destroys Helicobacter pylori and restores mucous membranes.
  • The drug has few contraindications: age under 4 years, pregnancy, lactation, hypersensitivity, taking other drugs with bismuth, renal and liver failure.
  • Adverse reactions of the drug are few and reversible, that is, they disappear after discontinuation of the drug.
  • The differences between Ulcavis and Bismuth tripotassium dicitrate lie only in the manufacturers of the active substances: for the drug Ulcavis, the Slovenian company KRKA uses raw materials from Germany, and domestic companies from Russia and China. The patient can choose any of them taking into account his own preferences.

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