II. Indications
III. Contraindications: Bismuth Subsalicylate
- Salicylate allergy
- Concurrent use with other Salicylates OR Warfarin (relative contraindication)
- Children and teens (relative contraindication)
- Due to Reye's Syndrome risk
- Avoid especially with febrile illness, Varicella Zoster Virus or Influenza
- Do not exceed 3 weeks of use (or 2 days of use for Acute Diarrhea)
IV. Mechanism
- Bismuth salt of salicylic acid with minimal gastrointestinal absorption
- Protects gastric mucosa from local acid and pepsin corrosive effects
- Antimicrobial activity
V. Preparations
- Bismuth Subsalicylate (Original Pepto-Bismol)
- Chewable Tablets 262 mg
- Suspension 262 mg/15 ml
- Caplets 262 mg
-
Calcium Carbonate
- Children's Pepto-Bismol
VI. Dosing: Acute Diarrhea
- Tablet: Two tabs orally four times daily up to maximum of every 4 hours
- Adult
- Take 2 tablets or 30 ml every 30 to 60 minutes as needed
- Maximum of 8 doses/day (240 ml/day) and up to 2 days
- Child
- Give 100 mg/kg/day divided in 5 doses for up to 2 days
- Age 3 to 6 years old
- Give 1/3 of a 262 mg chewable tablet every 30 to 60 min up to 8 doses/day OR
- Give 5 ml of 262 mg/15 ml suspension every 30 to 60 min up to 8 doses/day
- Age 7 to 9 years old
- Give 2/3 of a 262 mg chewable tablet every 30 to 60 min up to 8 doses/day OR
- Give10 ml of 262 mg/15 ml suspension every 30 to 60 min up to 8 doses/day
- Age 10 to 12 years old
- Give 1 of a 262 mg chewable tablet every 30 to 60 min up to 8 doses/day OR
- Give 15 ml of 262 mg/15 ml suspension every 30 to 60 min up to 8 doses/day
VII. Dosing: Chronic Infant Diarrhea
- Age 2 to 24 months (up to age 2): Give 2.5 ml of 262 mg/15 ml suspension orally every 4 hours as needed
- Age 25 to 48 months (up to age 4): Give 5 ml of 262 mg/15 ml suspension orally every 4 hours as needed
- Age 49 to 70 months (>age 4 years): Give 10 ml of 262 mg/15 ml suspension orally every 4 hours as needed
VIII. Dosing: Traveler's Diarrhea Prevention
- Adult
- Take 2 tabs four times daily before meals and at bedtime (2.1 grams/day)
IX. Safety
- Pregnancy Category C
- Avoid in Lactation
X. Adverse Effects
- See Salicylates
- Turns Tongue and stool black
- Mild Tinnitus
XI. Drug Interactions
- May potentiate other medications
- Oral Anticoagulants
- Hypoglycemic agents
- Decreases effect of other drugs
- Uricosurics (Probenecid, Sulfinpryazone)
- Tetracyclines
- May decrease Bioavailability of Doxycycline, Tetracycline
- Doxycycline is used for Malaria Prophylaxis
XII. Resources
- Bismuth Subsalicylate Tablet (DailyMed)
- Bismuth Subsalicylate Chewable (DailyMed)
XIII. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia