Bismuth Subnitrate and Iodoform Paste Impregnated Gauze

Bismuth Subnitrate and Iodoform Paste Impregnated Gauze Uses, Dosage, Side Effects, Food Interaction and all others data.

Bismuth subnitrate, also referred to as bismuth oxynitrate or bismuthyl nitrate, is a highly water-soluble crystalline compound that has been used as a treatment for duodenal ulcers and anti-diarrheic agent . The use of bismuth substrate as an active ingredient in over-the-counter antacids is approved by the FDA.

Bismuth subnitrate acts as an antacid that exert protective effects on the gastric mucosa . In a double-blind endoscopically controlled study, bismuth substrate was demonstrated to be effective for symptomatic relief in duodenal ulcers . In the alcohol model of mucosal injury in the rat, bismuth substrate was shown to be cytoprotective . In a randomized clinical study consisting of patients with H. pylori-associated duodenal ulcer, adjunctive use of colloidal bismuth subnitrate in a short treatment regimen with omeprazole and clarithromycin resulted in improved eradication rate of H. pylori .

Iodoform is an organoiodine compound with the formula CHI3 and a tetrahedral molecular geometry. It is a relatively water-insoluble yellow solid that is chemically reactive in free-radical reactions . Due to its antimicrobial properties following topical administration, minimal levels of iodoform may be found in disinfectants and it is more primarily used for veterinary purposes. Iodoform has also been found in dental paste and root canal filling materials in combination with other intracanal medications due to its radiopacity . Since the beginning of the 20th century, iodoform has been commonly used as a healing and antiseptic dressing or powder for wounds and sores, however such clinical use to this date is limited. Iodoform is soluble in fatty acids and decomposes releasing iodine in nascent state (96,7% of iodine) when in contact with secretions or endodontic infections .

Iodoform exhibits antibacterial activities after topical application. In a comparative study of wound dressing agents, iodoform gauze exerted an antibacterial effect 3 hours after the start of bacterial growth of E. coli and subsequently maintained the strong antibacterial effectiveness . A study demonstrated that direct and indirect exposure to high concentrations of iodoform induces a cytotoxic effect on cultures of macrophages and epithelial cells in vitro, while cell proliferation was enhanced at low concentrations of iodoform . This cytotoxic effect of iodoform in root canals may further lead to long-term local irritation to follicles of permanent successors and formation of cyst-like radiolucent defects .

Bismuth Subnitrate and Iodoform Paste Impregnated Gauze
Uses
Dosage
Side Effect
Precautions
Interactions
Uses during Pregnancy
Uses during Breastfeeding
Accute Overdose
Food Interaction
Half Life
Volume of Distribution
Clearance
Interaction With other Medicine
Contradiction
Storage

Trade Name	Bismuth Subnitrate and Iodoform Paste Impregnated Gauze
Generic	bismuth subnitrate + iodoform
Type
Therapeutic Class
Manufacturer	Martindale Pharma, an Ethypharm Group Company
Available Country	United Kingdom
Last Updated:	September 19, 2023 at 7:00 am

Bismuth Subnitrate and Iodoform Paste Impregnated Gauze

Uses

Bismuth subnitrate is a medication used as an antacid.

Indicated for over-the-counter use as an antacid.

No approved therapeutic indications.

How Bismuth Subnitrate and Iodoform Paste Impregnated Gauze works

Based on the findings of a clinical investigation in patients with duodenal ulcer disease and healthy volunteers receiving oral bismuth subnitrate tablets, the protective effects of bismuth subnitrate may be secondary to endogenous mucosal prostaglandin (PGE2) production, which is one of the deficient factors observed in peptic ulcer disease . Antacid neutralizing activity of bismuth subnitrate was demonstrated to have a significant postprandial effect on gastric pH .

While the mechanism of action of iodoform remains unclear, it is proposed that iodoform releases iodine, which denatures bacterial proteins by oxidation of the free iodine . Iodoform may also play a role in chemical debridement for effective necrotic wound healing and tissue damage repair via collagen fibrinolysis; upon treatment in necrotic tissue, iodoform reduced the size of the macromolecules containing collagen I in wound surface proteins . In human gingival fibroblasts in vitro, high concentrations of iodoform was shown to decrease the viability of macrophages and epithelial cells and reduced the secretion of P. gingivalis-induced TNFα . P. gingivalis is an anaerobic bacteria present in anaerobic oral niches including periapical sites and periodontal pockets .

Toxicity

Reported oral dose range for moderate toxicity or possibly lethal toxicity in humans is 0.5-5 g/kg . Nephropathy, encephalopathy, osteoarthropathy, gingivitis, stomatitis and colitis have been attributed to bismuth toxicity in humans .

Oral LD50, dermal LD50, and inhalation LC50 in rat are 355 mg/kg, 1184 mg/kg, and 165 ppm/7h, respectively . Fatal dose of iodoform in humans is estimated to be 2 g . Systemic intoxication and severe poisoning, mostly characterized by dermatitis, headache, somnolence, delirium, hallucinations, consciousness disturbances, coma, vomiting, CNS depression, tachycardia, and rapid feeble pulse, may result from excess absorption through wounds and abscesses, or ingestion of large quantities . While there is no known antidote for iodoform overdose, supportive and symptomatic treatment is highly recommended .

Hepatocellular damage has been observed with iodoform toxicity, where production of both fatty liver and necrosis was seen, as well as lesions of liver membranous cellular components . Iodoform induces hepatocellular injury and hepatic lesions in a similar manner to carbon tetrachloride, where cellular membranes may possibly be primary sites of action .

Volume of Distribution

Bismuth has been shown to accumulate preferentially in the kidneys .

No pharmacokinetic data available.

Elimination Route

Bismuth subnitrate may undergo minimal gastrointestinal absorption which may be potentiated with concomitant administration of sulfhydryl compounds when dissolved in citrate buffer solution . Approximately 0.2% of orally administered bismuth is absorbed systematically from the gastrointestinal tract with the peak plasma concentration typically occurring within 1 hour .

Iodoform is reported to be absorbed through denuded skin, wounds or mucous membranes .