Drug –Drug interactions.
Can a person take Aspirin with “Pepto-Bismol” Bismuth?
The generic name Aspirin belongs to a group of compounds termed as Salicylates. It is usually in the form of “acetyl salicylic acid”. The compound works with different properties in different concentrations. At a low dose it has a anti platelet effect. At a slightly increased dose it has more of an antipyretic effect and analgesic effect. At a high dose it has anti-inflammatory effects, by the inhibition of COX1 and COX2 mechanisms. It is usually taken fro the use in rheumatoid arthritis and osteoarthritis. It is also given in case of SLE. It is commonly used in case mild headaches as an analgesic. It is taken regularly by patients who have had a heart attack in the past and need low dose blood thinning agents. One of the most common side effects apart from salicylate hypersensitivity is its erosion of the gastric mucosa.
Pepto-Bismol is a brand name of the drug Bismuth sub-salicylate. It is used for the condition of epi gastric discomfort/ pain, acidity etc. it is a pro-drug and once ingested gets metabolized into bismuth and salicylic acid. The bismuth has a topical effect on the gastric acid secretions, which it reduces. It also has some anti microbial effects. The usage of both drugs together carries the risk of increase in levels of salicylic acid in blood which can have adverse effects.
Aspirin is an over the counter, readily available drug, which comes in various preparations, some are coated to decrease gastric irritation and the others are not. According to the readily available literature, aspirin is strictly discouraged in people who flu symptoms or chicken pox or if people have bleeding disorders. Especially in children with the above conditions, it should be avoided. Aspirin is known to cause a serious condition called Reye’s syndrome in children, since aspirin irritates the gastric mucosa, it should not be compounded with other foods or drinks that do the same. Therefore, avoiding alcohol or coffee is advised, as it increases gastric irritation and the risk of gastric bleeding, leading to Hemet-emesis and tarry stools. It is recommended that aspirin be avoided if patients have bleeding disorders, liver diseases, and high blood pressure or if the person is allergic to non steroidal anti-inflammatory drugs like Advil. Lodine, voltaren, toradol etc.
Bismuth sub-salicylate is used usually as an antacid agent , to neutralize the acidic ph in the gastric mucosa and reduce mucosal irritation by the acid, by creating a coating effect. It is also given in cases of acute diarrhea as it has a small anti microbial effect as well. According to available literature, Bismuth salts are contraindicated to people who are hypersensitive to the compound or to salicylates. As with aspirin, bismuth salts are cautioned in children and contraindication in pregnancy. People with coagulopathies must take great caution when using this drug. Caution is advised to patients who try to consume two or more drugs with similar compounds. Bismuth sub-salicylate is a pro drug which releases bismuth and salicylic acid in the stomach. Aspirin is salicylic acid in itself. So the use of both drugs together gives a compounding effect. The serum or blood levels of salicylate rise and this in turn increases the risk of toxic effects of the compound. it is due to this reason that the FDA has revised its warning concerning use of over the counter products which contain salicylate. According to the warning, aspirin and non aspirin drugs, all will have to inform the consumers about the dangers of taking these drugs, especially in children and people recovering from flu. It warns them about the risk of Reye’s syndrome and liver damage. Food and Drug Administration, HHS (2003).
A study shows that use of both compounds carries the risk of likely developing salicylic acid toxicity, which can show itself by way of tinnitus and sensory neural hearing loss Peleg U (2007).
All in all we can state that if aspirin is being consumed in low doses, i.e. by cardiac patients, who are adults and do not have flu like symptoms, it is advised that they consume both drugs with caution, knowing well the risks of toxicity. It the patient is a child or has flu like symptoms, or if the aspirin is being consumed in high dosage, then it is best advised that Pepto-Bismol and aspirin be not taken at the same time.
Peleg U, Perez R, Freeman S, Sohmer H. (2007), Salicylate ototoxicity and its implications for cochlear microphonic potential generation, Journal of basic clinical physiology and pharmacology, 18(3):173-88
Food and Drug Administration, HHS (2003), Labeling for oral and rectal over-the-counter drug products containing aspirin and non aspirin salicylates; Reye’s Syndrome warning. Final rule, Federal Register, 68(74):18861-9.