Drugs List

Therapeutic Indications

Uses

Epistaxis
Packing small to medium cavities after ear, nose and throat surgery

Contraindications

Breastfeeding
Pregnancy

Precautions and Warnings

Hyperthyroidism

Discard any unused portion
Not for use in open wounds
Monitor for signs of neurological toxicity on long term therapy
Discontinue treatment if rash occurs
Fire hazard: Keep away from naked flames and potential sources of ignition

Pregnancy and Lactation

Pregnancy

Bismuth subnitrate and iodoform preparations are contraindicated in pregnancy.

Iodoform releases iodine slowly when applied to tissues. If absorbed, iodine or iodides cross the placenta and have the potential, notably when used for prolonged periods or near to term, to cause hypothyroidism and goitre in the foetus and newborn. Iodine absorbed from topical preparations (e.g. povidone iodine) has been demonstrated to affect the mother and foetus.

There is insufficient evidence to assess the risk posed by bismuth, if absorbed from the preparation.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Bismuth subnitrate and iodoform preparations are contraindicated in breastfeeding.

Iodoform releases iodine slowly when applied to tissues. If absorbed, iodine concentrates in breast milk. Iodine absorbed from mucous membranes (e.g. povidone iodine applied to vagina) has been demonstrated to produce grossly elevated iodide levels in breast fed infants.

It is not known how much, if any, bismuth is absorbed from this preparation, or its effects on human milk. If absorbed, bismuth is widely distributed in the body and has a long half life (approximately 5 days).

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Allergic reaction
CNS toxicity
Encephalopathy
Erythematous rash

Presentation

Paste containing bismuth subnitrate and iodoform presented alone or on a paste-impregnated gauze

Drugs List

Therapeutic Indications

Uses

Epistaxis
Packing small to medium cavities after ear, nose and throat surgery

Dosage

Adults

Elderly

Children

Contraindications

Breastfeeding
Pregnancy

Precautions and Warnings

Hyperthyroidism

Discard any unused portion
Not for use in open wounds
Monitor for signs of neurological toxicity on long term therapy
Discontinue treatment if rash occurs
Fire hazard: Keep away from naked flames and potential sources of ignition

Pregnancy and Lactation

Pregnancy

Bismuth subnitrate and iodoform preparations are contraindicated in pregnancy.

Iodoform releases iodine slowly when applied to tissues. If absorbed, iodine or iodides cross the placenta and have the potential, notably when used for prolonged periods or near to term, to cause hypothyroidism and goitre in the foetus and newborn. Iodine absorbed from topical preparations (e.g. povidone iodine) has been demonstrated to affect the mother and foetus.

There is insufficient evidence to assess the risk posed by bismuth, if absorbed from the preparation.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Bismuth subnitrate and iodoform preparations are contraindicated in breastfeeding.

Iodoform releases iodine slowly when applied to tissues. If absorbed, iodine concentrates in breast milk. Iodine absorbed from mucous membranes (e.g. povidone iodine applied to vagina) has been demonstrated to produce grossly elevated iodide levels in breast fed infants.

It is not known how much, if any, bismuth is absorbed from this preparation, or its effects on human milk. If absorbed, bismuth is widely distributed in the body and has a long half life (approximately 5 days).

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Allergic reaction
CNS toxicity
Encephalopathy
Erythematous rash

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: November 2014

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

Summary of Product Characteristics: Bismuth Subnitrate and Iodoform Paste Impregnated Gauze. Aurum Pharmaceuticals Ltd. Revised July 2002.

Summary of Product Characteristics Bismuth Subnitrate & Iodoform Paste For Gauze. Aurum Pharmaceuticals Ltd. Revised January 2007.