Pharmacokinetics and Toxicity of Bismuth Compounds

Abstract

Inorganic bismuth salts are poorly soluble in water: solubility is influenced by the acidity of the medium and the presence of certain compounds with (hydr)oxy or sulfhydryl groups. The analysis of bismuth in biological material is not standardised and is subject to large variation; it is difficult to compare data from different studies, and older data should be approached with caution. The normal concentration of bismuth in blood is between 1 and 15 micrograms/L, but absorption from oral preparations produces a significant rise. Distribution of bismuth in the organs is largely independent of the compound administered or the route of administration: the concentration in kidney is always highest and the substance is also retained there for a long time. It is bound to a bismuth-metal binding protein in the kidney, the synthesis of which can be induced by the metal itself. Elimination from the body takes place by the urinary and faecal routes, but the exact proportion contributed by each route is still unknown. Elimination from blood displays multicompartment pharmacokinetics, the shortest half-life described in humans being 3.5 minutes, and the longest 17 to 22 years. A number of toxic effects have been attributed to bismuth compounds in humans: nephropathy, encephalopathy, osteoarthropathy, gingivitis, stomatitis and colitis. Whether hepatitis is a side effect, however, is open to dispute. Each of these adverse effects is associated with certain bismuth compounds. Bismuth encephalopathy occurred in France as an epidemic of toxicity and was associated with the intake of inorganic salts including bismuth subnitrate, subcarbonate and subgallate. In the prodromal phase patients developed problems in walking, standing or writing, deterioration of memory, changes in behaviour, insomnia and muscle cramps, together with several psychiatric symptoms. The manifest phase started abruptly and was characterised by changes in awareness, myoclonia, astasia and/or abasia and dysarthria. Patients recovered spontaneously after discontinuation of bismuth. Intestinal lavage, forced diuresis and haemodialysis have been tried without positive effects on the clinical condition of the patient or on blood bismuth concentration, and the use of dimercaprol as an antidote has produced reports of both positive and negative findings. To confirm the diagnosis of bismuth encephalopathy, it is essential to find elevated bismuth concentrations in blood, plasma, serum or CSF. A safety level of 50 micrograms/L and an alarm level of 100 micrograms/L have been suggested in the past, but no proof is available to support the choice of these levels.(ABSTRACT TRUNCATED AT 400 WORDS)

Lead‐Free Hybrid Perovskite Absorbers for Viable Application: Can We Eat the Cake and Have It too?

“…More importantly, it is much less toxic than Pb,177, 178 and has been used in organic synthesis and medicines 179, 180, 181. Hence, Bi‐based perovskite or hybrid materials are attractive options to replace lead perovskites.…”

Cloud point extraction spectrophotometric determination of trace quantities of bismuth in urine

“…Stock Bi(III) solution (1000 μg mL -1 ) was prepared by dissolving 0.2312 g of Bi(NO 3 ) 3 .5H 2 O (Merck) in 3 mL 5 mol L -1 nitric acid and diluting to the mark with water in a 100 mL volumetric flask. Triton X-114 stock solution (2% v/v) was prepared by dissolving 2 mL of concentrated solution (Merck) in hot distilled water.…”

“…As the uses of bismuth in medicine increases, it has spread in the environment and the chance of exposure of organisms to bismuth has increased. 3 Therefore, determination of bismuth at ultra-trace levels in environmental and biological samples is important.…”

Competitive Binding of Bismuth to Transferrin and Albumin in Aqueous Solution and in Blood Plasma

“…However, the molecular basis for the mechanism of action of bismuth drugs is not well understood, including bismuth-induced toxicity, especially encephalopathy, which led to the withdrawal of bismuth drugs in France and Australia in the 1970s (1). The diagnosis of encephalopathy is generally defined by the detection of bismuth in blood, plasma or serum, the so-called "Hillemand safety level" (6,7). Bismuth is primarily present in red blood cells, possibly binding to glutathione, with the remainder in serum or plasma (8 -10).…”