Medicine & USMLE

Bismuth & Sucralfate

Gastrointestinal Pharm
  1. H2 Blockers (Cimetidine, Ranitidine, Famotidine)
  2. Proton Pump Inhibitors (PPIs)
  3. Misoprostol
  4. Orlistat
  5. Antacids
  6. Bismuth & Sucralfate
  7. Octreotide
  8. Diphenoxylate vs. Loperamide
  9. Ondansetron
  10. Metoclopramide
  11. Bulk-forming Laxatives
  12. Senna
  13. Docusate
  14. Aprepitant


Bismuth and sucralfate are mucosal protectants used to treat GI ulcers. Bismuth is also used to treat secretory diarrhea by reducing intestinal motility. Both these drugs have minimal side effects, but bismuth use may lead to harmless black stools.

Key Points

  • Bismuth, Sucralfate
    • Drug Names:
      • Bismuth
      • Sucralfate
    • Mechanism:
      • Bind/cover/protect ulcers
        • Bind to ulcer base, providing physical protection and allowing HCO3- secretion to reestablish pH gradient in the mucous layer
      • Sucralfate requires acidic environment, not given with PPIs/H2 blockers
    • Clinical Use
      • Increases ulcer healing
        • Used for peptic ulcer disease
        • Quadruple therapy for H pylori gastritis (BMT Regimen)
          • Does not kill H. pylori, but rather improves ulcer healing
      • Bismuth can treat secretory (watery) diarrhea
        • Reduces intestinal motility
        • Often used in the treatment of Traveler’s diarrhea
    • Adverse effects:
      • Bismuth:
        • Harmless black coloring of stool