A small case series about the potential use of bismuth salicylate, the active ingredient in Pepto-Bismol for COVID-19, was recently peer-reviewed and published in Frontiers in Drug Discovery.
Pepto-Bismol is an over-the-counter drug for abdominal complaints like nausea, pain, and diarrhea. The active ingredient is bismuth subsalicylate (BSS).
In the study, most patients hospitalized with COVID-19 and given BSS for their diarrhea reduced their dependency on high-flow oxygen.
SARS-CoV-2, the virus that causes COVID-19, can attach to the respiratory tract, stomach, and intestines. That is why diarrhea is a common presentation of COVID-19.
Each participant had to receive at least four doses of BSS within 48 hours with a minimum total dose of at least 1096 mg.
The ages of the eight patients ranged from 38 to 79. All of them are high-risk due to other medical problems like coronary heart disease, diabetes, prostate cancer, hypertension, asthma, chronic obstructive lung disease (COPD), sleep apnea, and a recent deep venous thrombosis.
Before getting BSS, all of them were on high-flow oxygen (50 Liters/minute) either with a mechanical ventilator or Bilevel Positive Airway Pressure (BiPAP).
The patients were already treated with remdesivir, monoclonal antibodies, and dexamethasone for several days with minimal improvement. However, when BSS was given, they had significant improvement.
Their oxygen requirements decreased from 50 Liters/minute to 10 Liters/minute to as low as 1 L/min on one patient.
Five out of eight (62.5%) strongly responded positively to BSS regarding lower oxygen need.
In addition, seven of eight patients (87.5%) who received Pepto-Bismol got dramatically better. No side effects of BSS treatment were observed.
How does Bismuth Subsalicylate work for COVID-19?
The Front Line Critical Care Alliance (FLCCC) diagram shows that COVID-19 has several phases. The acute phase is when the SARS-CoV-2 actively multiplies inside the cells, and the latter phase is when the body’s immune response against the virus acts against the patient.
The result of this study looks like Pepto-Bismol also works during the latter phase of COVID-19. In their discussion, the authors cited research that shows that some SARS-CoV-2 viruses may continue to live inside the lung tissues even during the latter phase.[2]
This continued replication of the virus may be responsible for its prolonged course, and administration of BSS, even in the latter phase of COVID-19, may still be helpful.
In their discussion, the authors cited Shu et al., that bismuth salts prevent the enzymes needed by the SARS-CoV-2 virus for replication.[3]
Research by Yuan et al. showed that ranitidine bismuth citrate decreased SARS-CoV-2 by a thousandfold in animal models.[5]
In a small study on humans with COVID-19, Yacyshyn and colleagues showed that of those who received Pepto-Bismol for 48 hours, 50% had no more COVID-19 virus in their saliva.[4]
Additionally, bismuth has anti-inflammatory, anti-secretory, and anti-microbial properties.[6] which is helpful in the latter phase of COVID-19.
Earlier use of Bismuth Subsalicylate for COVID-19
In the study by Kahlenborn et al., the BSS was given when the patients were already hospitalized. They wonder what, if BSS had been given earlier, the COVID-19 hospitalization would have been prevented.
(The study is a retrospective study where the authors reviewed the hospital records at the end of the outcomes, which is why they do not control what drugs the patients were given.)
My thoughts on this are that Bismuth subsalicylate did what remdesivir, monoclonal antibodies, and the steroid dexamethasone failed to do. A clinical trial that compares bismuth subsalicylate to the mentioned medications would be interesting.
However, that will not happen since BSS is generic, and there will be no drug company that will earn billions of dollars in promoting it.
Benefits more than Risks
BSS has salicylate, like aspirin, and there can be a risk of intestinal bleeding. It can also cause abdominal bloating and discomfort.
People with aspirin allergies should not take it. BSS can cause dark stools due to the bismuth, but that is harmless and goes away.
Those with kidney disease should talk to their doctor before taking BSS since it can worsen renal function. More precautions about BSS can be found on Healthjade.com.
Overall, for most people, there is more benefit than risks in taking the inexpensive BSS for early signs of COVID-19.
There are many other forms of bismuth subsalicylate:
- Equate – least expensive ($0.17/Count)
- Bismarex
- Bismatrol
- Bismatrol Maximum Strength
- Kaopectate
- Kola-Pectin DS
- Peptic Relief
- Pepto-Bismol
- Percy Medicine
- Pink Bismuth
- Soothe Caplets
- Pepto-Bismol Maximum Strength
- Maximum Strength Stress
- Stress Maximum Strength
- Kaopectate Extra Strength
- Maalox Total Stomach Relief
- Kapectolin (New Formula)
- Kao-Tin Bismuth Subsalicylate Formula
- Kaopectate Anti-Diarrheal Upset Stomach Reliever
- K-Pek
- Pepto-Bismol InstaCool
- Kaopectate Diarrhea And Upset Stomach
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Reference:
- Kahlenborn C, Severs WB and Nawab K (2022) Bismuth subsalicylate as potential treatment for Covid-19 pneumonia: A case series report. Front. Drug. Discov. 2:962988. doi: 10.3389/fddsv.2022.962988
- Zhao, J., Yuan, Q., Wang, H., Liu, W., Liao, X., Su, Y., et al. (2020). Antibody responses to SARS-CoV-2 in patients with novel coronavirus disease 2019. Clin. Infect. Dis. 71, 2027–2034. doi:10.1093/cid/ciaa344
- Shu, T., Huang, M., Wu, D., Ren, Y., Zhang, X., Han, Y., et al. (2020). SARS-Coronavirus-2 Nsp13 possesses NTPase and RNA helicase activities that can Be inhibited by bismuth salts. Virol. Sin. 35 (3), 321–329. doi:10.1007/s12250-020-00242-1
- Yacyshyn MB et al. Feasibility study of Bismuth Subsalicylate (BSS) as an addition to standard of care for COVID-19 therapy. Curr Ther Res Clin Exp. 2022;96:100667. doi: 10.1016/j.curtheres.2022.100667. Epub 2022 Mar 30. PMID: 35370296; PMCID: PMC8964506.
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Yuan, S., Wang, R., Chan, J. F., Jinxia, A., Cheng, T., Ka-Heng, K., et al. (2020). Metallodrug ranitidine bismuth citrate suppresses SARS-CoV-2 replication and relieves virus-associated pneumonia in Syrian hamsters. Nat. Microbiol. 5, 1439–1448. doi:10.1038/s41564-020-00802-x
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Pasricha, P. J. (2006). “Treatment of disorders of bowel motility and water flux; antiemetics: Agents used in biliary and pancreatic disease” in Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 11th ed. (New York, NY: McGraw-Hill), 983–1008.
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