비스무트 서브살리실레이트

지사제 / 위장관 보호제

비스무트 서브살리실레이트는 일반의약품으로 판매되는 위장관 보호제 및 지사제입니다. 수의학에서는 주로 급성 분비성 설사를 관리하고 헬리코박터(*Helicobacter*) 위장관 감염을 치료하기 위한 '3제 요법'의 구성 요소로 사용됩니다. **임상 주의사항:** - 모화합물은 위장관에서 분해되어 **살리실산**을 방출합니다. - **고양이 사용 시 주의:** 고양이는 글루쿠론산 포합 대사 경로가 결핍되어 있어 살리실산에 매우 민감합니다. 고용량 또는 반복 투여 시 살리실산 중독을 쉽게 유발할 수 있습니다. - 방사선 불투과성이 있어 위장관 방사선 검사를 방해할 수 있습니다. - 보호자들은 비스무트로 인해 발생하는 무해한 흑색변을 흑색변(위장관 출혈)으로 오인하는 경우가 많습니다.

작용 기전: Bismuth subsalicylate is cleaved in the small intestine into **bismuth carbonate** and **salicylate**. - **Bismuth component:** Provides physical mucosal protection, binds bacterial endotoxins, and exhibits weak antibacterial properties (which contributes to its efficacy against *Helicobacter* spp.). - **Salicylate component:** Inhibits **cyclooxygenase (COX)** enzymes → decreases **prostaglandin** synthesis → reduces intestinal inflammation and hypersecretion, effectively mitigating clinical signs of secretory diarrhea.

동물 종별 용량

Cats

For diarrhea · 0.25 mL/kg · PO · q4-6h · Cats are sensitive to salicylates and probably should not receive frequent or high dosages
For diarrhea · 0.5-1 mL/kg · PO · q12h · 3 days · Using 'Pepto-Bismol Regular' or equivalent strength (17.5 mg/mL) liquid
For diarrhea in kittens and young cats · 1-2 mL · PO · 3-4 times a day · Refrigeration may increase palatability
For eliminating Helicobacter gastritis infections (triple therapy) · 0.22 mL/kg · PO · q4-6h · 3 weeks · Given with Metronidazole 15.4 mg/kg q8h and amoxicillin 11 mg/kg q8h

Ferrets

For eliminating Helicobacter gastritis infections (triple therapy) · 7.5 mg/kg · PO · q8h · 3-4 weeks · Given with Metronidazole 20 mg/kg and amoxicillin 30 mg/kg
For eliminating Helicobacter gastritis infections (triple therapy) · 17.5 mg/kg · PO · q8h · 21 days · Given with Metronidazole 20 mg/kg PO q12h, amoxicillin 20 mg/kg PO q12h, famotidine 0.5 mg/kg PO once daily, and sucralfate 25 mg/kg PO q8h

Cattle

For diarrhea in calves · 60 mL · PO · two to four times a day · two days
For diarrhea · 2-3 ounces · PO · 2-4 times a day

Horses

투여 경로

금기

Pre-existing bleeding disorders
Known hypersensitivity to salicylates
Use with extreme caution, if at all, in cats

이상반응

Constipation or fecal impaction (especially in infants or debilitated patients)
Stool discoloration (gray-black or greenish-black)
Salicylism / salicylate toxicity (especially in cats or at high doses)

약물 상호작용

Tetracycline · Bismuth can decrease the absorption of orally administered tetracyclines. Separate administration by at least 2 hours and give tetracycline first.
Aspirin · Concomitant administration may increase salicylate serum levels, increasing the risk of toxicity.

모니터링

Clinical efficacy (resolution of diarrhea)
Fluid and electrolyte status in severe diarrhea
Signs of salicylate toxicity (especially in cats)

과용량

Bismuth subsalicylate liquid/suspension contains approximately **8.7 mg/mL salicylate**. > **Note:** Two tablespoonsful (30 mL) is approximately equivalent to one 325 mg aspirin tablet. High doses can lead to **salicylism** (salicylate toxicity), which may manifest as gastrointestinal ulceration, bleeding, acid-base disturbances, and neurological signs. Cats are particularly vulnerable to overdose due to their deficient glucuronidation metabolism.

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