Bismuth subgallate



Bismuth subgallate is a medication used to deodorize flatulence and stools as well as hemostasis in soft tissue surgery.

Generic Name
Bismuth subgallate
DrugBank Accession Number

Bismuth subgallate is a yellow colored substance that presents as an odorless powder that undergoes discoloration when exposed to sunlight. It is a heavy metal salt of gallic acid that is highly insoluble and poorly absorbed. Possessing protective effects on the gastric mucosa, strong astringent effects, and not as yet elucidated antimicrobial and hemostatic actions, bismuth subgallate is most commonly available as an over-the-counter internal deodorant where it is often employed as the primary active ingredient.

Small Molecule
Average: 394.091
Monoisotopic: 393.98901
Chemical Formula
  • basic bismuth 3,4,5-trihydroxybenzoate
  • basisches Wismutgallat
  • Bismuth subgallate
  • Bismuto subgalato
  • gallic acid bismuth basic salt
  • Wismutgallathydroxid



The most common medical purpose for which bismuth subgallate is currently and formally indicated for is the use as a non-prescription internal deodorant product for the purpose of deodorizing flatulence and stools 12,13,1.

Additionally, there are also various non-prescription (over the counter) bismuth subgallate based wound healing products as well as ongoing studies into whether or not the substance can be utilized as a legitimate hemostatic agent - usually for soft tissue surgery in otorhinolaryngology and/or dermatologic settings 2,3,4,5.

Moreover, in the past bismuth subgallate may have seen some use as a treatment for Helicobacter pylori infection 6. In contrast, contemporary first-line therapies generally involve proton pump inhibitor and antibiotic combination therapies that generally achieve high rates of pathogen eradication, ease of administration, and patient compliance.

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Associated Conditions
Indication TypeIndicationCombined Product DetailsApproval LevelAge GroupPatient CharacteristicsDose Form
Used in combination for symptomatic treatment ofAnal fissuresCombination Product in combination with: Hydrocortisone acetate (DB14539), Benzocaine (DB01086), Benzalkonium (DB11105)•••••••••••••••••
Used in combination for symptomatic treatment ofHemorrhoidsCombination Product in combination with: Benzalkonium (DB11105), Hydrocortisone acetate (DB14539), Benzocaine (DB01086)•••••••••••••••••
Treatment ofMalodorous flatulence••• ••••••••• ••••••••
Used in combination for symptomatic treatment ofPruritus aniCombination Product in combination with: Benzalkonium (DB11105), Hydrocortisone acetate (DB14539), Benzocaine (DB01086)•••••••••••••••••
Treatment ofMalodorous stool••• ••••••••• ••••••••
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Bismuth subgallate is a heavy metal salt that is relatively insoluble and poorly absorbed 4,14. As a result, systemic absorption is not necessary 14 or possibly even desired when the agent is administered orally or onto specific otorhinolaryngology and/or dermatologic wound sites where it can execute its pharmacologic action directly within the gastrointestinal lumen 14 to deodorize flatulence and stools or potentially elicit a hemostatic effect on wounds 4.

Additionally, like other bismuth agents, one of the most common side effects associated with bismuth subgallate is its propensity to cause a black discoloration of the tongue and stools when the agent combines with trace amounts of sulfur in the saliva and/or gastrointestinal tract 15. This discoloration is temporary and harmless, gradually dissipating over a number of days and eventually disappearing after the discontinuation of the bismuth agent 15.

Mechanism of action

Bismuth salts exert their action largely in the upper gastrointestinal tract by way of local activity from luminal bismuth in the stomach and duodenum 6.

In terms of bismuth subgallate's ability to deodorize flatulence and stools as an internal deodorant - although not fully elucidated - it is believed that when the substance is administered orally, its relative insolubility and poor absorption allows it to remain within the gastrointestinal lumen and inhibit colonic bacteria from acting on fermentable food residues in the GI tract 14.

Moreover, when bismuth subgallate is taken orally, various salts like bismuth citrate, bismuth oxychloride, and others are formed 6. These salts are then taken up into surrounding gastric mucus as well as bound to protein within the base of any ulcers that may be present after coming into contact with gastric juice 6. Additionally, bismuth compounds like bismuth subgallate are also believed to have the capacity to trigger the secretion of prostaglandins, epithelial growth factor (EGF), and mucosal bicarbonate as a means to inhibit the action of pepsin in gastric juice 6. These actions subsequently protect gastric mucous from peptic luminal degradation as well as enhance the properties of mucous to assist in the healing of both duodenal and gastric ulcers 6. In this way, bismuth subgallate works to absorb extra water and/or toxins in the large intestine, allowing it to form a protective coat on the intestinal mucosa and over ulcers that may or may not be associated with infections like those of Helicobacter pylori 13.

Furthermore, studies have shown that bismuth compounds like bismuth subgallate are capable of demonstrating antimicrobial effects against various gastrointestinal tract pathogens like E. coli, Salmonella, Shigella, Vibrio cholera, Campylobacter jejuni, H. pylori, and some enteric viruses like Rotaviruses 6. Although the exact mechanism(s) of action by which bismuth compounds are able to elicit such antimicrobial effects remains unclear 6, a number of experimental observations suggest that bismuth has been able to complex with the bacterial wall and periplasmic membrane; inhibit bacterial enzymes like urease, catalase, and lipase; inhibit bacterial protein and ATP synthesis; and also inhibit or decrease the adherence of bacteria like H. pylori to epithelial cells 6. In essence, ultrastructural studies have shown evidence of the binding of bismuth complexes to the bacterial wall and periplasmic space between the inner and outer bacterial membrane of H.pylori with subsequent ballooning and disintegration of the pathogen 6. To various extents, these antimicrobial actions may also illustrate how bismuth subgallate is capable of neutralizing colonic bacteria from acting on fermentable foods as well.

Numerous studies have and continue to study the possible hemostatic action that bismuth subgallate may have. As the bismuth salt of gallic acid, bismuth subgallate's chemical structure shares similarities to ellagic acid, another gallic acid derivative 7. Ellagic acid itself is a clot-promoting agent that initiates thrombin formation by way of the intrinsic pathway via an action on Hageman factor (clotting factor XII) 7,4. It is believed that bismuth subgallate's ability to activate factor XII is associated with the chemical's negatively charged moieties - whose contact with factor XII would theoretically initiate the intrinsic pathway to blood clotting 7.

Other studies have also suggested that bismuth subgallate is capable of inducing macrophages to secrete growth factors to facilitate wound healing, decreasing lesion area, enhancing granulation tissue formation and re-epithelialization, the initiation of the proliferation of collagen via the activation of fibroblasts, the accelerated re-establishment of blood vessels, and also the restriction of nitric oxide formation 5,8.

Given such studies regarding bismuth subgallate's potential hemostatic abilities, there has been and continues to be interest in indicating the agent for use in otolaryngology as in tonsillectomies or adenotonsillectomies to achieve reduced bleeding and surgery times; topical treatment in various open wound surgeries to facilitate faster and earlier clotting between tissues; ileostomy; dental surgeries; epistaxis management; among others 2,4. Nevertheless, study results are conflicting; where there may be experimental results suggesting some improvements in reduced operation time and operative blood loss when bismuth subgallate is used as a hemostatic agent in tonsillectomies 7 there are also study results that observed bismuth subgallate having a negative influence on the healing processes of wounds inflicted in animal models, in which the use of the agent actually delayed the rate of new vessel formation and optimal wound healing 4.

Finally, bismuth subgallate also demonstrates a strong astringent ability 4 - an action that can facilitate both its deodorant and hemostatic effects and assists in its indication as an active ingredient in a number of non-prescription products for hemorrhoid suppositories or topical applications, diarrhea, etc 14.


Bismuth subgallate is only slightly, if at all, absorbed after oral ingestion 14. The general human oral bioavailability of bismuth subgallate has been reported as low as 0.04% 14. Any absorption that does occur is likely to happen from the upper small intestine 6.

The gastrointestinal absorption of bismuth from bismuth compounds demonstrates a large interindividual variation 14. Factors affecting the absorption involve the formulation of the bismuth subgallate compound as well as the dietary factors of the individuals themselves 6. Nevertheless, absorption can be enhanced with the concomitant intake of citrate and sulfhydryl-group-containing compounds 14. Conversely, the simultaneous administration of antacids or a diet that is high in thiol content can lower absorption of bismuth subgallate 6.

Volume of distribution

In general, oral administration is one of the most common routes of administration for non-prescription bismuth subgallate products and gastrointestinal and systemic absorption is usually very low.

Protein binding

In general, any systemic absorption of bismuth subgallate is expected to be low but any bismuth that is absorbed is also expected to bind to plasma proteins 6 and be distributed throughout all tissues 6, with the highest concentration found in the kidney 14,6 and lower levels in the lung, spleen, liver, brain, bone, and muscle 14.

The bismuth component itself is generally known to demonstrate a high percentage binding to plasma proteins of >90% 16.


No specific metabolism of bismuth is known 14. In the kidney it induces the de novo synthesis of a bismuth-metal-binding protein, which is a kind of methallothionein 14.

Route of elimination

Ingested bismuth is primarily eliminated unabsorbed by way of the faeces 14. Any absorbed bismuth is eliminated from the body by both the urinary and faecal (including bile) routes 14. Excretion of absorbed bismuth in the urine is rapid, with most of the metal excreted within 24 hours 6. About 10% of the absorbed bismuth is detected in faeces, presumably owing to biliary secretion 6.


The bismuth component of bismuth subgallate is known to have a terminal half-life of 21-72 days 16.


On average, the blood clearance of the bismuth component of a bismuth salt like bismuth subgallate is within the range of 50 to 95 ml/min 9.

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Depending on the level of severity of a patient's renal impairment, administration of bismuth compounds may not be appropriate as the reduced renal clearance can lead to undesirably elevated blood levels of bismuth 6. Similarly, because of the biliary excretion of bismuth, severe liver disease may theoretically result in accumulation of bismuth as well 6.

Bismuth toxicity seemingly develops only from excessive dosage (perhaps from ingestion of bismuth over a prolonged time or intramuscular injections) and is characterized by nephrotoxicity, osteoarthropathy, encephalopathy, hepatotoxicity, stomatitis, and gingivitis 6. However, the insoluble inorganic bismuth compounds are reported to be mainly associated with reversible encephalopathy 6. In fact a number of studies have discussed how patients may experience a syndrome of subacute, progressive encephalopathy involving potential aphasia, myoclonous, and/or gait instability after taking bismuth subgallate in large quantities well over the usual recommended dosages 10,11. This kind of encephalopathy is usually reversible with the discontinuation of the bismuth subgallate usage however 10,11.

Not Available
Pharmacogenomic Effects/ADRs
Not Available


Drug Interactions
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
AbacavirAbacavir may decrease the excretion rate of Bismuth subgallate which could result in a higher serum level.
AceclofenacAceclofenac may decrease the excretion rate of Bismuth subgallate which could result in a higher serum level.
AcemetacinAcemetacin may decrease the excretion rate of Bismuth subgallate which could result in a higher serum level.
AcetaminophenAcetaminophen may decrease the excretion rate of Bismuth subgallate which could result in a higher serum level.
AcetazolamideAcetazolamide may increase the excretion rate of Bismuth subgallate which could result in a lower serum level and potentially a reduction in efficacy.
Food Interactions
No interactions found.


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International/Other Brands
Over the Counter Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
DevromTablet, chewable200 mg/1OralThe Parthenon Co., Inc.2018-12-01Not applicableUS flag
DevromCapsule200 mg/1OralThe Parthenon Co., Inc.2018-12-01Not applicableUS flag
Devrom Chew Tab 200mgTablet, chewable200 mgOralThe Parthenon Company Inc.1978-12-312022-04-27Canada flag
Mixture Products
NameIngredientsDosageRouteLabellerMarketing StartMarketing EndRegionImage
BISMUTH SUBGALLATE COMPOUND SUPPOSITORIES BP 80Bismuth subgallate (200 mg) + Zinc oxide (120 mg)SuppositoryRectalMEDIPHARM PTE LTD1998-10-16Not applicableSingapore flag
HEMORALGINE 40 GR POMADBismuth subgallate (2 g) + Aluminum subacetate (0.4 g) + Chlorhexidine hydrochloride (0.4 g) + Ephedrine hydrochloride (0.2 g) + Levomenthol (0.8 g) + Tetracaine hydrochloride (0.4 g) + Zinc oxide (3.2 g)OintmentTopicalATABAY İLAÇ FABRİKASI A.Ş.1991-07-19Not applicableTurkey flag
KORTOS KREM, 30 GBismuth subgallate (2 %) + Benzalkonium chloride (0.1 %) + Benzocaine (2.5 %) + Hydrocortisone acetate (0.5 %)CreamTopicalEXELTIS İLAÇ SAN. VE TİC. A.Ş.1997-08-11Not applicableTurkey flag
ROWATANAL CREAMBismuth subgallate (2 g/100g) + Calcium carbonate (5 g/100g) + Levomenthol (1 g/100g) + Zinc oxide (8 g/100g)CreamRectalDCH AURIGA (MALAYSIA) SDN. BHD.2020-09-08Not applicableMalaysia flag


Drug Categories
Chemical TaxonomyProvided by Classyfire
This compound belongs to the class of organic compounds known as gallic acid and derivatives. These are compounds containing a 3,4,5-trihydroxybenzoic acid moiety.
Organic compounds
Super Class
Benzene and substituted derivatives
Sub Class
Benzoic acids and derivatives
Direct Parent
Gallic acid and derivatives
Alternative Parents
Benzoic acids / Benzoyl derivatives / Phenoxides / 1-hydroxy-4-unsubstituted benzenoids / 1-hydroxy-2-unsubstituted benzenoids / Monocarboxylic acids and derivatives / Carboxylic acids / Organooxygen compounds / Organic salts / Organic oxoanionic compounds
show 2 more
1-hydroxy-2-unsubstituted benzenoid / 1-hydroxy-4-unsubstituted benzenoid / Aromatic homomonocyclic compound / Benzoic acid / Benzoyl / Carboxylic acid / Carboxylic acid derivative / Gallic acid or derivatives / Hydrocarbon derivative / Monocarboxylic acid or derivatives
show 7 more
Molecular Framework
Aromatic homomonocyclic compounds
External Descriptors
bismuth coordination entity (CHEBI:31292)
Affected organisms
  • Humans and other mammals

Chemical Identifiers

CAS number
InChI Key
2,7-dihydroxy-2H-benzo[d]1,3-dioxa-2-bismacyclopentane-5-carboxylic acid


General References
  1. Sparberg M: Correspondence: Bismuth subgallate as an effective means for the control of ileostomy odor: a double blind study. Gastroenterology. 1974 Mar;66(3):476. [Article]
  2. Tramontina VA, Machado MA, Nogueira Filho Gda R, Kim SH, Vizzioli MR, Toledo Sd: Effect of bismuth subgallate (local hemostatic agent) on wound healing in rats. Histological and histometric findings. Braz Dent J. 2002;13(1):11-6. [Article]
  3. Puia SA, Renou SJ, Rey EA, Guglielmotti MB, Bozzini CE: Effect of bismuth subgallate (a hemostatic agent) on bone repair; a histologic, radiographic and histomorphometric study in rats. Int J Oral Maxillofac Surg. 2009 Jul;38(7):785-9. doi: 10.1016/j.ijom.2009.03.003. Epub 2009 Apr 16. [Article]
  4. Couto EV, Ballin CR, Sampaio CP, Maeda CA, Ballin CH, Dassi CS, Miura LY: Experimental study on the effects of bismuth subgallate on the inflammatory process and angiogenesis of the oral mucosa. Braz J Otorhinolaryngol. 2016 Jan-Feb;82(1):17-25. doi: 10.1016/j.bjorl.2014.12.009. Epub 2015 Oct 27. [Article]
  5. Mai LM, Lin CY, Chen CY, Tsai YC: Synergistic effect of bismuth subgallate and borneol, the major components of Sulbogin, on the healing of skin wound. Biomaterials. 2003 Aug;24(18):3005-12. [Article]
  6. Lambert JR, Midolo P: The actions of bismuth in the treatment of Helicobacter pylori infection. Aliment Pharmacol Ther. 1997 Apr;11 Suppl 1:27-33. [Article]
  7. Agrawal SR, Jain AK, Marathe D, Agrawal R: The effect of bismuth subgallate as haemostatic agent in tonsillectomy. Indian J Otolaryngol Head Neck Surg. 2005 Oct;57(4):287-9. doi: 10.1007/BF02907688. [Article]
  8. Vyas KS, Vasconez HC: Wound Healing: Biologics, Skin Substitutes, Biomembranes and Scaffolds. Healthcare (Basel). 2014 Sep 10;2(3):356-400. doi: 10.3390/healthcare2030356. [Article]
  9. Benet LZ: Safety and pharmacokinetics: colloidal bismuth subcitrate. Scand J Gastroenterol Suppl. 1991;185:29-35. [Article]
  10. Sampognaro P, Vo KT, Richie M, Blanc PD, Keenan K: Bismuth Subgallate Toxicity in the Age of Online Supplement Use. Neurologist. 2017 Nov;22(6):237-240. doi: 10.1097/NRL.0000000000000144. [Article]
  11. Burns R, Thomas DW, Barron VJ: Reversible encephalopathy possibly associated with bismuth subgallate ingestion. Br Med J. 1974 Feb 9;1(5901):220-3. [Article]
  12. Devrom Internal Deodorant (200 mg bismuth sabgallate) [Link]
  13. Bismuth Subgallate Monograph [Link]
  15. Pepto-Bismol: Why does Pepto-Bismol sometimes darken the tongue/stool and how long does it last? [Link]
  16. ScienceDirect: Bismuth subgallate [Link]
  17. TITCK Product Information: Kortos (bismuth subgallate/benzocaine/benzalkonium chloride/hydrocortisone acetate) rectal cream [Link]
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Clinical Trials

Clinical Trials
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PhaseStatusPurposeConditionsCountStart DateWhy Stopped100+ additional columns
3CompletedTreatmentHaemorrhoids1somestatusstop reasonjust information to hide


Not Available
Not Available
Dosage Forms
SuppositoryRectal200 mg
CapsuleOral200 mg/1
Tablet, chewableOral200 mg/1
Tablet, chewableOral200 mg
TabletOral400 mg / tab
Not Available
Not Available


Experimental Properties
water solubilityInsoluble in cold water and hot water.MSDS
Predicted Properties
Water Solubility44.8 mg/mLALOGPS
pKa (Strongest Acidic)3.93Chemaxon
pKa (Strongest Basic)-2.3Chemaxon
Physiological Charge-1Chemaxon
Hydrogen Acceptor Count6Chemaxon
Hydrogen Donor Count3Chemaxon
Polar Surface Area96.22 Å2Chemaxon
Rotatable Bond Count1Chemaxon
Refractivity39.39 m3·mol-1Chemaxon
Polarizability17.9 Å3Chemaxon
Number of Rings2Chemaxon
Rule of FiveYesChemaxon
Ghose FilterNoChemaxon
Veber's RuleNoChemaxon
MDDR-like RuleNoChemaxon
Predicted ADMET Features
Not Available


Mass Spec (NIST)
Not Available
Not Available
Chromatographic Properties
Collision Cross Sections (CCS)
Not Available


Pharmacological action
General Function
Toxic substance binding
Specific Function
Serum albumin, the main protein of plasma, has a good binding capacity for water, Ca(2+), Na(+), K(+), fatty acids, hormones, bilirubin and drugs. Its main function is the regulation of the colloid...
Gene Name
Uniprot ID
Uniprot Name
Serum albumin
Molecular Weight
69365.94 Da
  1. Lambert JR, Midolo P: The actions of bismuth in the treatment of Helicobacter pylori infection. Aliment Pharmacol Ther. 1997 Apr;11 Suppl 1:27-33. [Article]

Drug created at September 18, 2017 20:57 / Updated at July 14, 2024 17:59