Bismuth Salts
Kelas obat: Agen Antineoplastik
Panganggone Bismuth Salts
Diare
Bismuth subsalicylate digunakake minangka obat mandiri ing bocah-bocah lan wong diwasa kanggo ngontrol gejala diare nonspesifik akut lan diare lelungan.
Bismuth subsalicylate wis digunakake ing wong diwasa kanggo nyegah diare lelungan† [off-label]; nanging, kurang efektif tinimbang agen anti-infèksi.
Infeksi Helicobacter pylori lan Penyakit Ulser Duodenum
Bismuth subsalicylate digunakake kanggo perawatan infeksi Helicobacter pylori lan penyakit ulcer duodenum (penyakit aktif utawa riwayat ulcer duodenum); pemberantasan H. pylori ditampilake nyuda risiko kambuh ulkus duodenum.
Bismuth subsalicylate digunakake ing regimen macem-macem obat sing uga kalebu metronidazole, tetracycline hydrochloride, lan antagonis reseptor H2 histamin utawa inhibitor pompa proton (terapi quadruple); kombinasi obat kasebut dianjurake dening American College of Gastroenterology (ACG) minangka pilihan perawatan baris pisanan kanggo pemberantasan infeksi H. pylori. ACG nyaranake nimbang regimen obat quadruple kasebut ing pasien alergi penisilin lan sing sadurunge wis nampa antibiotik macrolide. Yen regimen 14 dina awal ora mbasmi H. pylori, mundur karo regimen obat pirang-pirang sing ora kalebu metronidazole kanggo nyegah pangembangan resistensi metronidazole.
Rejimen macem-macem obat kalebu bismuth subsalicylate, metronidazole, tetracycline hydrochloride, lan inhibitor pompa proton (tinimbang antagonis reseptor histamin H2) bisa uga luwih efektif nglawan galur H. pylori sing tahan metronidazole; regimen kasebut disaranake dening ACG minangka pilihan perawatan sing bisa ditampa kanggo infeksi H. pylori sing terus-terusan ("perawatan penyelamat").
Kombinasi tetep sing ngemot bismut suBCitrate potassium, metronidazole, lan tetracycline hydrochloride (Pylera) sing digunakake bebarengan karo omeprazole kanggo perawatan infeksi H. pylori lan ulkus duodenum (ulkus aktif utawa riwayat ulkus duodenum sajrone 5 taun kepungkur).
Kembung utawa Bau Bangku
Bismuth subgallate digunakake minangka obat mandiri ing bocah lan wong diwasa kanggo nyuda kembung utawa ambune feces saka colostomy utawa ileostomy.
Bismuth subgallate wis digunakake minangka obat mandiri kanggo nyuda ambu ora enak saka inkontinensia fecal† [off-label], sindrom irritable bowel† [off-label], utawa operasi bariatric† [off-label].
Bismuth subgallate ora samesthine efektif kanggo nyuda ambu saka karesikan pribadi sing salah† [off-label].
Dyspepsia (Lambung Kesel)
Bismuth subsalicylate digunakake minangka obat mandiri ing bocah-bocah lan wong diwasa kanggo nyuda gejala dyspepsia (contone, mual, mual, heartburn, fullness, belching, gas) sekunder kanggo overdulgence. ing pangan lan ngombe.
Efektivitas uyah bismut ing perawatan dyspepsia nonulcer† ora mesthi. Ora dianjurake minangka terapi lini pertama amarga potensial risiko neurotoxicity kanthi panggunaan jangka panjang; bisa migunani minangka agen baris kapindho.
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Carane nggunakake Bismuth Salts
Administrasi
Administrasi Oral
KapsulBismuth subgallate: Diwenehake kanthi lisan nganti 4 kali saben dina nalika mangan. Kapsul ditelan wutuh.
Kalium subcitrate bismuth ing kombinasi tetep karo metronidazole lan tetracycline hydrochloride (Pylera): Diwenehake kanthi lisan kaping 4 saben dina sawise mangan lan sadurunge turu; menehi omeprazole bebarengan minangka bagéan saka regimen. (Waca Kombinasi Tetep Ngandhut Bismuth Subcitrate Potassium, Metronidazole, lan Tetracycline Hydrochloride [Pylera] miturut Dosis.) Ngulu kapsul kabeh. Diwenehi kanthi banyu segelas lengkap (240 ml), utamane kanthi dosis sadurunge turu, kanggo nyuda resiko iritasi esophagus lan ulcerasi dening komponen tetracycline hydrochloride. Yen dosis Pylera ora kejawab, njupuk dosis sabanjure ing wektu sing dijadwalake kanthi rutin; aja pindho dosis. Hubungi dokter yen >4 dosis ora kejawab.
SuspensiBismuth subsalicylate: Goyang suspensi sadurunge administrasi. Gunakake cangkir dosis sing diwenehake dening pabrikan kanggo dosis sing akurat. Kanggo Diotame, copot tutup lan wenehake dosis sing cocog kanthi ngempit tabung.
Tablet ChewableBismuth subgallate: Diwenehake kanthi lisan nganti 4 kali saben dina karo dhaharan. Ngunyah utawa ngulu kabeh.
Bismuth subsalicylate: Mamah utawa larut ing tutuk lan ngulu.
Bismuth subsalicylate (karo metronidazole lan tetracycline hydrochloride ing Helidac Therapy kit): Diwenehi saben komponen kanthi lisan 4 kali saben dina nalika mangan lan sadurunge turu. Ngunyah lan ngulu tablet bismuth subsalicylate. Atur komponen tetracycline hydrochloride lan metronidazole kanthi kaca lengkap (240 mL) banyu, utamane karo dosis sadurunge turu, kanggo ngurangi risiko iritasi esofagus lan ulceration dening komponen tetracycline hydrochloride. Yen dosis Terapi Helidac ora kejawab, njupuk dosis sabanjure ing wektu sing dijadwalake kanthi rutin; aja pindho dosis. Yen luwih saka 4 dosis ora kejawab, hubungi dokter.
Tablet KonvensionalBismuth subsalicylate (contone, Pepto-Bismol Easy-to-Swallow Caplets): Ngulu nganggo banyu; aja ngunyah.
Dosis
Kasedhiya minangka bismuth subgallate, bismuth subcitrate potassium, lan bismuth subsalicylate; dosis ditulis ing syarat-syarat uyah.
Bismuth subcitrate potassium kasedhiya ing kombinasi tetep karo metronidazole lan tetracycline hydrochloride (Pylera); dosis Pylera dituduhake minangka jumlah kapsul.
Pasien Anak
Diare Nonspesifik Akut lan Diare Wisatawan Bismuth Subsalicylate OralBocah ≥12 taun: 525 mg saben 30-60 menit utawa 1,05 g saben jam yen perlu, ora ngluwihi 4,2 g ing wektu 24 jam. Gunakake nganti diare mandheg, nanging ora luwih saka 2 dina.
Bocah ≥12 taun: Utawa, menehi 1,05 g saben 30 menit† saben jam yen perlu, ora ngluwihi 4,2 g ing wektu 24 jam.
Kembung utawa Bau Bangku Bismuth Subgallate OralBocah ≥12 taun: 200–400 mg nganti 4 kali dina.
Dispepsia (Perut Sakit) Bismuth Subsalicylate OralBocah ≥12 taun: 525 mg saben 30-60 menit yen perlu, ora ngluwihi 4,2 g ing wektu 24 jam. Aja nggunakake luwih saka 2 dina.
Bocah ≥12 taun: Utawa, menehi 1,05 g saben 30-60 menit† yen perlu, ora ngluwihi 4,2 g ing wektu 24 jam.
Dewasa
Diare Nonspesifik Akut lan Diare Wisatawan Bismuth Subsalicylate Oral525 mg saben 30-60 menit utawa 1,05 g saben jam yen perlu, ora ngluwihi 4,2 g ing 24 jam wektu. Gunakake nganti diare mandheg, nanging ora luwih saka 2 dina.
Utawa, menehi 1,05 g saben 30 menit† saben jam yen perlu, ora ngluwihi 4,2 g ing wektu 24 jam.
Nyegah Diare Wisatawan† Bismuth Subsalicylate Oral525 mg 4 kali dina wis dianjurake.
Infeksi Helicobacter pylori lan Penyakit Ulser Duodenum Bismuth subsalicylate, metronidazole, and tetracycline Hydrochloride Regimen Oral525 mg bismut subsalicylate bebarengan karo metronidazole (250 mg) lan tetracycline hydrochloride (500 mg) kaping 104 saben dina. 14 dina; menehi bebarengan karo ranitidine (150 mg) kaping pindho saben dina utawa dosis biasa saka inhibitor pompa proton sepisan utawa kaping pindho saben dina.
Terapi nylametake kanggo infeksi H. pylori sing terus-terusan: Diwenehake suwene 7-14 dina.
> Bismuth Subsalicylate (karo Metronidazole lan Tetracycline Hydrochloride) ing Helidac Therapy Kit Oral525 mg bismuth subsalicylate magepokan karo metronidazole (250 mg) lan tetracycline hydrochloride (500 mg) 4 kali dina (nalika mangan lan sadurunge turu) kanggo 14 dina; menehi bebarengan karo dosis biasa saka H2-reseptor antagonis.
Kombinasi Tetep Ngandhut Bismuth Subcitrate Potassium, Metronidazole, lan Tetracycline Hydrochloride (Pylera) Oral3 kapsul 4 kali dina (sawise mangan lan sadurunge turu) suwene 10 dina; menehi concomitantly karo omeprazole 20 mg kaping pindho saben dina (sawise esuk lan sore meal) kanggo 10 dina.
Kembung utawa Bau Tinja Bismuth Subgallate Oral200–400 mg nganti 4 kali dina.
Dispepsia (Mabuk Perut) Bismuth Subsalicylate Oral525 mg saben 30-60 menit yen perlu, ora ngluwihi 4,2 g ing wektu 24 jam. Aja nggunakake luwih saka 2 dina.
Utawa, menehi 1,05 g saben 30-60 menit† yen perlu, ora ngluwihi 4,2 g ing wektu 24 jam.
Batesan Resep
Pasien Anak
Diare Nonspesifik Akut lan Diare Wisatawan Bismuth Subsalicylate OralBocah ≥12 taun: Maksimum 4,2 g ing 24 jam wektu. Pangobatan mandiri ora kudu ngluwihi 2 dina.
Dispepsia (Mabuk Perut) Bismuth Subsalicylate OralBocah ≥12 taun: Maksimal 4,2 g ing wektu 24 jam. Pangobatan mandiri ora kudu ngluwihi 2 dina.
Dewasa
Diare Nonspesifik Akut lan Diare Wisatawan Bismuth Subsalicylate OralMaksimum 4,2 g ing wektu 24 jam. Pangobatan mandiri ora kudu ngluwihi 2 dina.
Dispepsia (Mabuk Perut) Bismuth Subsalicylate OralMaksimum 4,2 g ing wektu 24 jam. Pangobatan mandiri ora kudu ngluwihi 2 dina.
Populasi Khusus
Ora ana rekomendasi dosis populasi khusus ing wektu iki. (Deleng Panggunaan Geriatrik lan uga pirsani Gagal Ginjal, ing Cautions.)
Pènget
Contraindications
Pènget / PancegahanPènget
Gangguan GI
Aja nganggo bismuth subsalicylate (contone, Maalox Total relief) kanggo ngobati mandhiri ing pasien sing lara ulcer, kelainan getihen, utawa feces getih utawa ireng.
Sindrom ReyeRisiko sindrom Reye kanthi bismuth subsalicylate ing bocah-bocah utawa remaja sing duwe utawa lagi pulih saka gejala varicella utawa kaya influenza. (Deleng Panganggone Pediatrik ing Ati-ati.)
NeurotoxicityNeurotoxicity sing gegandhèngan karo dosis uyah bismut sing kakehan sing dilapurake arang; bisa dibalèkaké sawisé mungkasi obat kasebut.
Perubahan warna ilat lan/utawa bangkuMungkin dadi peteng lan ora mbebayani ing ilat lan/utawa bangkekan ireng; aja bingung stool darkening karo melena.
Isi TimbalBismut sing ditambang saka lemah, lan preparat Pepto-Bismol sing kasedhiya kanggo komersial, bisa uga ngemot timbal alami sing sithik. Jumlah timbal ing preparat Pepto-Bismol kurang dibandhingake karo paparan timbal saben dina rata-rata. Preparat Pepto-Bismol ora dimaksudake kanggo panggunaan kronis.
Reaksi Sensitivitas
HipersensitivitasBismuth subsalicylate ngandhut salisilat; aja digunakake ing pasien alergi salisilat (kalebu aspirin).
Pancegahan Umum
Pamilihan lan Panganggone Anti-infèksi ing Regimen H. pyloriKanggo nyuda pangembangan bakteri sing tahan obat lan njaga efektifitas Terapi Helidac, Pylera, lan agen anti-infèksi liyane, gunakake mung kanggo perawatan utawa nyegah infèksi sing kabukten utawa dicurigai banget disebabake dening bakteri sing rentan.
Nalika milih utawa ngowahi terapi anti-infèksi, gunakake asil kultur lan tes kerentanan in vitro. Yen ora ana data kasebut, nimbang epidemiologi lokal lan pola kerentanan nalika milih anti-infèksi kanggo terapi empiris.
PhenylketonuriaTablet chewable diotame ngandhut aspartam (NutraSweet), sing dimetabolisme ing saluran GI dadi phenylalanine sawise administrasi oral.
Panganggone Kombinasi Tetep utawa Kit Multiple-ObatNalika preparat kombinasi tetep sing ngandhut bismuth subcitrate potassium, metronidazole, lan tetracycline hydrochloride (Pylera) utawa kit sing ngemot bismuth subsalicylate, metronidazole, lan tetracycline hydrochloride (Terapi Helidac ) digunakake kanggo perawatan infeksi H. pylori lan penyakit ulkus duodenum, ati-ati, pancegahan, lan kontraindikasi sing ana gandhengane karo metronidazole lan tetracycline hydrochloride kudu dianggep saliyane sing ana gandhengane karo bismuth subcitrate potassium utawa bismuth subsalicylate.
Kesalahan PengobatanKesalahan obat sing serius wis dilaporake menyang FDA sing konsumen nggunakake Maalox Total Relief (bismuth subsalicylate) nalika arep nggunakake produk antacid cair Maalox tradisional sing ngemot aluminium hidroksida, magnesium hidroksida, lan simethicone (contone, Maalox Advanced Regular Strength, Maalox Advanced Maximum Strength). Amarga saka potensial kanggo efek salabetipun serius gadhah ora sengaja nggunakake bismuth subsalicylate (kang kimia related kanggo aspirin), Produsèn saka Maalox Total Relief pisanan sarujuk kanggo ngganti jeneng dagang produk kanggo siji sing ora kalebu "Maalox"; Nanging, pabrikan malah mandhegake persiapan bismuth subsalicylate ing musim panas 2010.
Populasi Tertentu
KandhutanBismuth subsalicylate: Kategori C (Kategori D ing trimester kaping 3).
Terapi Helidac, Pylera: Kategori D.
Terapi Helidac, Pylera: Efek ing tenaga kerja lan pangiriman ora dingerteni.
LaktasiBismuth subsalicylate: Gunakake kanthi ati-ati.
Terapi Helidac, Pylera: Mungkasi nyusoni utawa obat kasebut.
Panggunaan PediatrikAja nggunakake bismuth subsalicylate ing bocah-bocah utawa remaja sing duwe utawa lagi pulih saka gejala varicella utawa influenza. Owah-owahan prilaku sing diiringi mual lan muntah ing bocah utawa remaja sing njupuk obat kasebut bisa dadi tandha awal sindrom Reye.
Keamanan lan kesahihan kit Terapi Helidac sing kasedhiya kanthi komersial utawa persiapan kombinasi tetep Pylera ing pasien pediatrik sing kena infeksi H. pylori durung ditetepake. Pylera utawa Helidac Therapy kit ngirim ora digunakake ing bocah-bocah <8 taun. (Deleng Kontraindikasi ing Cathetan.)
Panggunaan GeriatrikPengalaman sing ora cukup ing umur ≥65 taun kanggo nemtokake manawa dheweke nanggapi beda karo wong diwasa sing luwih enom kanggo kit Terapi Helidac sing kasedhiya kanthi komersial utawa persiapan kombinasi tetep utawa Pylera kanggo perawatan saka infèksi H. pylori lan penyakit ulcer duodenal.
Pikirake penurunan fungsi ati, ginjel, lan/utawa jantung sing ana hubungane karo umur lan penyakit bebarengan lan terapi obat.
Gangguan HepatikAkumulasi uyah bismut bisa kedadeyan ing pasien sing nandhang penyakit ati sing abot. Kit Terapi Helidac sing kasedhiya kanthi komersial lan persiapan kombinasi tetep Pylera dikontraindikasi ing pasien kanthi gangguan hepatik. (Deleng Kontraindikasi ing Cautions lan uga ndeleng Populasi Khusus ing Farmakokinetik.)
Gagal GinjalGunakake bismuth subsalicylate kanthi ati-ati, yen ana, ing pasien kanthi gangguan ginjel. Kit Terapi Helidac sing kasedhiya kanthi komersial lan persiapan kombinasi tetep Pylera dikontraindikasi ing pasien sing nandhang gagal ginjel. (Deleng Contraindications ing Cautions.)
Efek Umum sing Sabar
Bismuth: Ilat dadi peteng lan ora mbebayani lan/utawa feces ireng, peristalsis mudhun (karo bismuth subgallate).
Terapi Helidac: Mual, diare, nyeri weteng, melena, infèksi ambegan ndhuwur.
Pylera: kelainan feces, diare, dyspepsia, nyeri weteng, mual, sirah, sindrom flu, perversion rasa, asthenia, vaginitis, pusing.
Apa obatan liyane bakal mengaruhi Bismuth Salts
Obat Spesifik lan Tes Laboratorium
Obat utawa Tes
Interaksi
Komentar
Antikoagulan
Garam salisilat (contone, bismuth subsalicylate) bisa nambah risiko getihen. kanthi terapi antikoagulan bebarengan
Monitor terapi antikoagulan; nyetel dosis antikoagulan yen perlu
Agen antidiabetik
Mungkin efek hipoglikemik sing bisa ditingkatake kanthi terapi uyah salisilat bebarengan
Gunakake kanthi ati-ati
Aspirin
p>Gunakake kanthi ati-ati
Ciprofloxacin
Bismuth subsalicylate rada nyuda konsentrasi plasma puncak lan AUC ciprofloxacin
Ora dianggep penting sacara klinis
Doxycycline
Bismuth subsalicylate bisa nyuda penyerapan doxycycline
Aja nggunakake bismuth subsalicylate kanggo obat mandiri ing lelungan sing njupuk doxycycline kanggo profilaksis malaria
Methotrexate
Aja nggunakake bismuth subsalicylate kanggo obat mandiri bebarengan karo metotreksat
Omeprazole
Omeprazole nambah tingkat panyerepan bismut saka kapsul Pylera sawise administrasi bebarengan
Probenecid
Gunakake bebarengan kanthi ati-ati, yen kabeh
Pencitraan radiografi (radiographs )
Bismuth nyerep sinar-x; bisa ngganggu prosedur diagnostik radiografi saluran GI
Salisilat
Aja nggunakake bismuth subsalicylate kanggo obat mandiri bebarengan karo obat salisilat liyane
Sulfinpyrazone
Gunakake bebarengan kanthi ati-ati
Tes getih gaib
Daening feces saka uyah bismut ora ngganggu tes kanggo getih gaib
Tetracycline
Bismut lan/utawa kalsium karbonat (excipient saka tablet bismuth subsalicylate) nyuda penyerapan sistemik saka tetracycline ; penting klinis ora dingerteni amarga kontribusi relatif saka aktivitas antimikroba sistemik versus lokal marang H. pylori ora ditemtokake
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