Efficacy reduced if adminstered simultaneously with antacids,tetracyclines,and H2 receptor antagonists.

To control fecal odors in colostomy , ileostomy or incontinence

Possibility of bismuth poisoning and fatal encephalopathy in patients with renal impairment or if given in excessive doses for unusually prolonged periods. Darkening of tongue or stools.

Renal insuffciency. Pregnancy & lactation.Children below 14yrs.

Special Precautions:

No food,milk or antacids to be taken 60 mins before or after the drug.

Indication-

To control fecal odors in colostomy , ileostomy or incontinence

Dosage-

Take 1 or 2 tablets daily with meals. Chew or swallow whole

List of entries                                                                                                               1. Indigestion 2. Heartburn 3. Dysphagia 4. Flatulance 5. Anorexia                                              6. Nausea, Vomiting and Retching 7. Gastritis 8. Diarrhea and Constipation                            9. Irritable bowel syndrome 10. Gastrointestinal Reflux                                                            11.Reflux Oesophagitis  12. Peptic Ulcer - Zollinger- Ellison Syndrome                                     13. Duodenal Ulcer 14.Gastric Ulcer

1. Indigestion- Indigestion is a term frequently used to describe a multitude of             symptoms generally appreciated with the distress with the intake of food.To some        patients indigestion refers to a feeling that digestion has not proceeded naturally.          They may describe a sense of abdominal fullness, pressure or actual pain.                Others may use the term to describe heartburn, belching, distention or flatulence. Indigestion may occur as a result of disease of the gastrointestinal tract or in          association with pathologic states in other organs

2. Heartburn- Heartburn or pyrosis is a sensation of warmth or burning located substernally or high in the epigastrium. Experimental studies in human beings                  have shown that esophageal distention or increased motor activity is associated                in most subjects with a feeling of fullness and burning in this area. Heartburn                       may occur with organic disease of the intestinal tract and is usually associated with gastroesophageal reflux. This is frequently the case in hiatus hernia

3. Dysphagia- Dysphagia or difficulty in swallowing is a most reliable symptom and indicates the presence of disease or dysfunction Dysphagia should never be              dismissed as emotional disturbance or to be confused with globus hystericus,                    a term used to indicate the sensation of a lump or tightness in the throat            independent of swallowing

4. Flatulance- A significant amount of flatus is passed each day by normal persons        and the complaint of flatulence often reflects a heightened and embarassing            awareness of this natural occurence. Many who complain of gas are in reality         experiencing symptoms ascribable to disordered motility. Excessive passage                     of intestinal gas may be the result of aerophagia or the formation of increased          amounts of gas by intestinal bacteria.

5. Anorexia- Anorexia or loss of the desire to eat is a prominant symptom in a               wide variety of intestinal and extraintestinal disorders. Anorexia occurs in many           disorders and as a result by itself or of little specific diagnostic value. The              mechanism whereby hunger and appetite are modified in variousdiseases                       are poorly understood. Anorexia is commonly seen in diseases of the                        gastrointestinal tract and the liver.

6. Nausea, Vomiting and Retching- Nausea and vomiting may occur             independently    of each other, but generally they are so closely allied that they                   may conveniently be considered together. Nausea denotes the feeling of imminent            desire to vomit,usually referred to the throat or epigastrium. Vomiting refers to                    the forceful oral expulsion of gastric contents. Retching denotes the labored rhythmic respiratory activity that frequently precedes emesis. Nausea often precedes or accompanies vomiting. It is usually associated with diminished functional activity                of the stomach and alterations of the motility of the duodenum and small intestine.

7. Gastritis- Gastritis may be associated with recent alcohol ingestion or with                   the use of anti-inflammatory drugs, such as aspirin or indomethicin. Another frequent setting is the development of gastric erosions in stressful situations such as            following major trauma or surgery or in assocaition with severe systemic disease.          The occurence of gastritis in burn victims and patients with increased intracranial  pressure is also common.

8. Diarrhea and Constipation- The bowel habits of apparently healthy persons              vary widely. For this reasoon, the term diarrhea and constipation have most                 meaning when viewed as a change from an individuals customary pattern.          Reasonably detailed information is important in evaluating either abnormality.              When patients complain of diarrhea, it is important to obtain an estimate of the          volume as well as frequency of fecal output and in addition, to directly examine                   a stool for consistency, blood, oilness and malodor. The term constipation                       may be used by the patient to a variety of changes including reduction in                       frequency of defecation, a constant sensation of rectal fullness and incomplete               evacuation of feces and sometimes painful defecation due to hard stools or perianal pathology

9. Irritable bowel syndrome- The irritable bowel syndrome (also referred to                     as spastic colon and mucous colitis ) is one of the most frequent gastrointestinal  disorders. This condition is chracterized by periodic or chronic symptoms                          of diarrhea, constipation and abdominal pain. These symptoms are generally             associated with psychologic stresses, but the anxiety produced by the bowel               disturbance is sometimes regarded by the patient as the fundemental cause                          of emotional upset. Stools tend to be thin, fragmented or pellet like and                    accompanied by excessive mucus and gas.

10. Gastrointestinal Reflux- Reflux of small amounts of gastric juice into the                   lower part of the esiphagus is a common event. Its frequency is increased by over indulgence. Whether reflux occurs and whether it produces symptoms are                 determined by three factors                                                                                                      1. the competency of the lower esophageal sphincter , the primary barrier to reflux             2. the irriatant nature of the refuxed material and                                                                    3. the sensitivity of the esophageal mucosa to the refluxed material                           Although the symptoms of reflux were attributed in the past to inflammation of the esophagus ie. esophagitis. It is clear that esophagitis is a complication of                    severe reflux rather than the cause of the symptoms associated with reflux.

11. Reflux Oesophagitis-  Reflux esophagitis is inflammation of the esophageal          mucosa caused by reflux of acid gastric or alkaline intestinal juice. Esophagitis                    is the prcursor of the complications of reflux, namely, bleeding, stricture and                  change in esophageal epithelium from squamous to columnar. Bleeding is                    slow and chronic. Acute massive bleeding occassionally occurs with                               esophagitis but is usually due to an associated peptic ulcer of the esophagus.

12. Peptic Ulcer - Zollinger- Ellison Syndrome- Peptic ulcer is a term used to            refer to a group of ulceratrive disorders of the upper gastrointestinal tract,which            appears to have in common the participation of acid pepsin in their pathogensis.             The major forms are chronic duodenal and gastric ulcer.                                                   The Zollinger-Ellison syndrome gastrinome may also be considered a form                         of peptic ulcer.

13. Duodenal Ulcer- Duodenal ulcer is a chronic and recurrent disease.                              The ulcer is usally deep and sharply demarcated. It tends to penetrate through the submucosa and often into the muscularis propria. The ulcer floor contains no intact epithelium and usually consists of a zone of eosinophilic necrosis resting on a                     base of granulation tissue surrounded by variable amounts of fibrosis. The ulcer              bed may be clear or contain either blood or a proteinaceous exudate with entrapped erythrocytes and acute and chronic inflammatory cells.

14. Gastric Ulcer- Gastric ulcers, just like as duodenal ulcers, are more common              in males. They are also histologically similar to duodenal ulcers. Gastric ulcers are characterstically deep, extending beyond the mucosa of the stomach. Almost all                  benign gastric ulcers are located in the antrum, in a zone immediaterly distal                      to the junction of the antral mucosa with the acid-secreting mucosa of the body of the stomach.

BIsmuth sub salicylate-

1. Allergy- Tell your doctor if you ever had any unusual or allegic reaction to bismuth subsalicylate or other salicylates such as aspirin, including oil of winter green.

2. Diet- Tell your doctor if you are on any special diet, such as a low-sodium or low sugar diet.

3. Pregnancy- Occassional use of bismuth salicylate is not likely to cause problems            in the fetus or in the newborn. Salicylates have not shown to cause birth defects in humans. However, studies in animals have shown that salicylates may cause                birth defects. There is a chance that regular use of salicylates may cause unwanted effects on the heart or blood flow in the new born infant. Use of salicylates during              the last 2 weeks of pregnancy may cause bleeding problems in the fetus before                or during delivery or in the new born infant.

4. Breast feeding- Salicylates pass into breast milk. Although they have not been       shown to cause problems in nursing babies it is possible that problems may occur              if large amounts of salicylates are taken regularly.

Reports not available

Pregnancy-                                                                                                                     Occassional use of bismuth salicylate is not likely to cause problems in the fetus or in the newborn. Salicylates have not shown to cause birth defects in humans. However,           studies in animals have shown that salicylates may cause birth defects. There is a            chance that regular use of salicylates may cause unwanted effects on the heart or            blood flow in the new born infant. Use of salicylates during the last 2 weeks of             pregnancy may cause bleeding        problems in the fetus before or during delivery                 or in the new born infant.

Breast feeding-                                                                                                                         Salicylates pass into breast milk. Although they have not been shown to cause                 problems in nursing babies it is possible that problems may occur if large                            amounts of salicylates are taken regularly.