Do Bismuth subsalicylate and Sertraline interact? (3 tips)

In this article we will answer the question, “Does Bismuth subsalicylate and Sertraline interact?”. We will also discuss some tips to avoid the potential side effects of taking Bismuth subsalicylate and Sertraline together.

Do Bismuth subsalicylate and Sertraline interact?

Yes, Bismuth Subsalicylate interacts with Sertraline. These medications, when taken together, can increase the risk of serious bleeding.

Bismuth Subsalicylate is commonly used to alleviate gastrointestinal distress. It is an antacid and anti-diarrheal agent, usually available over the counter under the brand name Pepto-Bismol. (1)

Sertraline is the most widely prescribed antidepressant under the brand name Zoloft. It is classified as a Selective Serotonin Reuptake Inhibitor (SSRI) primarily prescribed to manage depression, anxiety, Obsessive Compulsive Disorder(OCD) and many other mental health conditions. (2)

Potential interactions between Bismuth Subsalicylate and Sertraline

Bismuth Subsalicylate provides gastric relief by creating a protective barrier around the stomach lining and reduces inflammation. It is widely used for relief from Traveller’s diarrhoea, nausea, heartburn and upset stomach.

The salicylate component, however, causes potential disruption in platelet function leading to increased chances of bleeding especially in patients with stomach ulcers. (1)

Sertaline is an SSRI and can also affect platelet function resulting in a blood thinning effect and increased risk for bleeding especially in patients with stomach ulcers. (2)

When Bismuth subsalicylate is used with Sertraline, the cumulative effect intensifies the risk of upper gastrointestinal bleeding. This includes black tarry stools, blood in stools, abdominal pain and cramping, nausea, vomiting, and upset stomach. (1) (2)

Certain groups of patients are more vulnerable to bleeding side effects such as;

  • Patients with bleeding disorders such as Haemophilia
  • Elderly patients with chronic comorbidities
  • Patients taking NSAIDs daily for arthritis or joint pain
  • Patients with stomach ulcers, liver and kidney problems

However rare but serious bleeding events can also occur with this combination. These include unexplained swelling, pain, red or brown urine, nosebleeds, unexpected vaginal bleeding, heavy menstruation, easy bruising, petechiae or red spots and bleeding from gums. (3)

Keep a close eye on these signs and symptoms if you have to take Bismuth subsalicylate and Sertraline together.

Sertraline interacts with many other medications such as antihistamines like Benadryl and NSAIDs like Ibuprofen.

How to avoid the potential side effects of Bismuth subsalicylate and Sertraline use?

Sometimes, healthcare providers may prescribe both Bismuth subsalicylate and Sertraline together when the potential benefits outweigh the associated risks.

In such cases, extra caution becomes essential to minimize the risk of side effects.
here are some ways to reduce the risk of bleeding

Time and dose adjustment

The most commonly employed strategy is to space the dosing of Bismuth subsalicylate and Sertraline. This involves taking two medications at different times during the day.

For instance, you can take one medication in the morning and the other in the evening. Additionally, your healthcare professional can consider reducing the dose of one or both medications to keep interaction at a minimum.

Avoid NSAIDs use

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin can also increase the risk of bleeding when used with bismuth subsalicyalte and Sertraline.

Therefore, it is advisable to avoid over-the-counter NSAIDs while taking these medications. If you require pain relief or anti-inflammatory treatment consult your healthcare provider for safer alternative options. (1) (2)

Be vigilant about side effects

Maintaining vigilance for any potential side effects is crucial when using these medications together. Any discomfort or unusual symptom should be reported promptly to your healthcare provider for swift action.

Early reporting allows your doctor to assess and address any emergency issue swiftly without leading to the worsening of the situation.


In conclusion, the combination of Bismuth subsalicylate and Sertraline present serious risks. While these medications can be effective individually, their interaction raises concerns about bleeding risks.

Vigilance in recognizing early signs of bleeding and proactive measures to minimize complications is essential for patient safety. It is crucial to report any unusual side effects to your healthcare provider promptly for your own safety.

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