How much aspirin is in pepto bismol tablets?

When using these ingredients, your bowel movements will appear almost black, and so might your tongue. Of course, both will go back to their normal color when you stop taking the medicine. Also, do not take Kaopectate or Pepto-Bismol if you’re allergic to aspirin. Bismuth subsalicylate is related to aspirin, so you could develop an allergic reaction.

Another important point: do not give Kaopectate or Pepto-Bismol to children or teenagers who have a fever without first contacting your child’s doctor. They belong to a group of medicines called “salicylates.” Youngsters who receive aspirin or other salicylates during a viral infection may develop Reye’s syndrome. This is a serious and sometimes deadly condition in children that can harm the brain and liver. To be safe, doctors recommend that you avoid giving your children aspirin and other salicylates any time they have a fever or a viral infection. Also, ask your doctor or pharmacist before you take Kaopectate or Pepto-Bismol if you’re also taking a prescription medicine for diabetes, gout, arthritis, or to prevent blood clots. If you take these medicines together, you could have a serious side effect, like bleeding.

Contents

bismuth subsalicylate (Bismarex, Bismatrol, Bismatrol Maximum Strength)

Brand Names: Bismarex, Bismatrol, Bismatrol Maximum Strength, Childrens Kaopectate, Kaopectate, Kaopectate Anti-Diarrheal Upset Stomach Reliever, Kaopectate Extra Strength, Kao-Tin Bismuth Subsalicylate Formula, Kapectolin (New Formula), Kola-Pectin DS, K-Pek, Maalox Total Stomach Relief, Peptic Relief, Pepto-Bismol, Pepto-Bismol InstaCool, Pepto-Bismol Maximum Strength, Percy Medicine, Pink Bismuth, Soothe Caplets, Soothe Chewable, Soothe Maximum Strength, Soothe Regular Strength, Stress Maximum Strength

Generic Name: bismuth subsalicylate

  • What is bismuth subsalicylate?
  • What are the possible side effects of bismuth subsalicylate?
  • What is the most important information I should know about bismuth subsalicylate?
  • What should I discuss with my health care provider before taking bismuth subsalicylate?
  • How should I take bismuth subsalicylate?
  • What happens if I miss a dose?
  • What happens if I overdose?
  • What should I avoid while taking bismuth subsalicylate?
  • What other drugs will affect bismuth subsalicylate?
  • Where can I get more information?

Bismuth subsalicylate is an antacid and anti-diarrhea medication.

Bismuth subsalicylate is used to treat diarrhea, nausea, heartburn, indigestion, and upset stomach.

Bismuth subsalicylate may also be used for purposes not listed in this medication guide.

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round, pink, imprinted with GDC 122

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round, pink, imprinted with RH 046

What are the possible side effects of bismuth subsalicylate?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop taking this medicine and call your doctor at once if you have:

  • hearing loss or ringing in your ears;
  • diarrhea lasting longer than 2 days; or
  • worsened stomach symptoms.

Common side effects include:

  • constipation;
  • dark colored stools; or
  • black or darkened tongue.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is the most important information I should know about bismuth subsalicylate?

Bismuth subsalicylate is used to treat diarrhea, nausea, heartburn, indigestion, and upset stomach.

This medication should not be given to a child or teenager who has a fever, especially if the child also has flu symptoms or chicken pox. Salicylates can cause a serious and sometimes fatal condition called Reye’s syndrome in children.

You should not use bismuth subsalicylate if you have a stomach ulcer, a recent history of stomach or intestinal bleeding, or if you are allergic to salicylates such as aspirin, Doan’s Extra Strength, Salflex, Tricosal, and others.

Bismuth Subsalicylate

What is bismuth subsalicylate?

Bismuth subsalicylate is an antacid and antidiarrheal active ingredient available in over-the-counter (OTC) medicines that treat heartburn, indigestion, upset stomach, nausea, diarrhea, and other gastrointestinal ailments.

What is bismuth subsalicylate used to treat?

  • Heartburn
  • Indigestion
  • Upset stomach
  • Nausea
  • Diarrhea
  • Other gastrointestinal ailments
Common brands containing bismuth subsalicylate:
  • Kaopectate®
  • Pepto-Bismol™
  • Store Brands (ex. Walmart’s “Equate” store brand or CVS Health store brand)

How much bismuth subsalicylate can you take?

Different types of products containing this active ingredient have different strengths. That’s why it is always important to read and follow the Drug Facts label. Most medicines warn against use of an active ingredient for longer than 7-10 days. Stop use and ask a doctor if symptoms persist.

Safety guide for bismuth subsalicylate

Bismuth subsalicylate is approved by the U.S. Food and Drug Administration (FDA) and is safe and effective when used according to the Drug Facts label. You may use the product as directed until diarrhea stops, but not for more than two days.

Ask a healthcare provider before use if:

  • You are taking a blood-thinning medicine (anticoagulant) or a prescription medicine to treat diabetes, gout, or arthritis.
  • You have a fever or mucus in the stool.
  • You are pregnant or breastfeeding.

Do not use if:

  • You are allergic to salicylates, including aspirin.
  • You are taking other medicines that contain salicylates.
  • You have an ulcer, bleeding problem, or bloody or black stool.

Stop use and ask a doctor if:

  • Your symptoms get worse.
  • You experience ringing in the ears or loss of hearing.
  • Your diarrhea lasts for more than two days.
  • You take too much. Immediately contact a healthcare provider or the poison control national helpline at 800.222.1222.

What are the side effects of bismuth subsalicylate?

  • When using medicines containing bismuth subsalicylate, a temporary and harmless darkening of the stool or tongue may occur.

Antimicrobial Agents

The primary mode of action of bismuth subsalicylate, the active ingredient of Pepto-Bismol, is as an antimicrobial agent. Bismuth subsalicylate disassociates in gastric acid to form bismuth salts, such as bismuth oxychloride. In addition to antimicrobial properties bismuth subsalicylate has anti-secretory properties and a potential for toxin adsorption. Salicylic acid is released as a byproduct of the reaction and is nearly completely absorbed. Chewing a total of eight Pepto-Bismol tablets/day is equivalent to taking 3–4 adult aspirin tablets. Although salicylic acid does not have the same anticoagulant properties as acetylsalicylic acid, travelers taking warfarin or non-steroidal anti-inflammatory agents should avoid bismuth subsalicylate.

Bismuth subsalicylate is an effective and safe agent for the prevention and treatment of travelers’ diarrhea.22 Protection ranges from 40% to 65%, according to the amount and frequency of the dose. For best protection it should be taken as two tablets chewed four times a day.6,11 The formation of black bismuth salts can discolor the tongue and the resultant blackened stools can mimic melena. Travelers should be advised to rinse their mouths thoroughly after each dose, and especially after the bedtime dose. Gently brushing the tongue at bedtime is recommended to help avoid the otherwise purely esthetic problem of black tongue. Theoretically, the absorbed salicylate may cause tinnitus, but in studies this occurred no more frequently in bismuth subsalicylate-treated patients than in placebo-treated patients. Care should be exercised when using bismuth subsalicylate in patients with impaired renal function. Bismuth subsalicylate can contribute to salicylate intoxication, so it should not be taken with aspirin. Encephalopathy has been anecdotally reported, but the bismuth in bismuth subsalicylate is essentially not absorbed compared to other bismuth compounds, so such reports are exceedingly rare. If doxycycline is used for malaria prevention, travelers should be cautioned not to use concurrent bismuth subsalicylate. The bivalent cations in bismuth subsalicylate preparations can lower the bioavailability of doxycycline.

Much of the early work on travelers’ diarrhea prevention focused on the use of prophylactic antimicrobials. Table 19.4 shows currently recommended6 antimicrobials with the suggested dosing regimens. Although antimicrobials have demonstrated clear efficacy in the prevention of travelers’ diarrhea, concerns include side-effects, promoting resistance development, and the use of antimicrobial agents for chemoprophylaxis of a self-limiting syndrome when those agents have more critical other uses.

Table 19.4. Currently Recommended Antimicrobials for the Prevention of Travelers’ Diarrhea

Antimicrobial Daily Oral Dose Adverse Effects/Comments
Bismuth subsalicylate 8 tabs chewed, in 4 divided doses Black tongue and stools. Potential for tinnitus and salicylate overdose
Do not use with Coumadin or non-steroidal anti-inflammatory agents
Fluoroquinolones
 Ofloxacin 300 mg GI upset, rash, dizziness, insomnia, and anxiety
Cannot be recommended in SE Asia
 Norfloxacin 400 mg
 Ciprofloxacin 500 mg
 Levofloxacin 500 mg
Rifaximin 200 mg No different from placebo. Dosage in SE Asia, where relatively resistant Campylobacter is prevalent, is uncertain; some recommend 200 mg BID or 400 mg daily.

Classic studies by Ben Kean noted the utility of the antibiotic neomycin in the prevention of travelers’ diarrhea. Then studies with doxycycline dosed at 100 mg/day showed it to be a highly protective agent. Increasing resistance to tetracyclines in developing regions of the world has rendered the use of tetracyclines obsolete.

Trimethoprim and the combination of trimethoprim and sulfamethoxazole (TMP/SMX) were historically the next generation of antimicrobials studied for prevention of diarrhea. These agents provided 71–95% protection in areas where resistance was low; however, rising resistance around the world has compromised the usefulness of these antimicrobials as well. Furthermore, TMP/SMX is ineffective against Campylobacter jejuni, an important cause of travelers’ diarrhea, particularly in SE Asia, where use of TMP/SMX cannot be recommended for prophylaxis or treatment. While TMP/SMX is relatively inexpensive, easy to administer, and can be used in children, its major disadvantages include rashes, hypersensitivity reactions (including Stevens–Johnson syndrome), bone marrow depression, and gastrointestinal disturbances. Serious side-effects are rare, but need to be considered when prescribing this drug for purposes of prophylaxis.

Until recently, fluoroquinolones were the drugs of choice as effective and relatively safe agents for the prevention of travelers’ diarrhea. A study reported in 1994 showed 84% protection.23 Unfortunately, fluoroquinolone resistance, particularly among C. jejuni, is increasingly being reported. In SE Asia, fluoroquinolones can no longer be recommended for prevention of travelers’ diarrhea. Adverse reactions to fluoroquinolones include rash, GI intolerance, and central nervous system stimulation manifested as insomnia, nervousness or dizziness. Fluoroquinolones should not be used in pregnant women. For this class of drugs the development of resistance in the community is important, since their broad spectrum of activity, including respiratory tract pathogens, has given them a wide range of clinical applications.

Azithromycin is an antibiotic with efficacy in the treatment of travelers’ diarrhea.24 This agent is attractive for its broad spectrum of activity against enteropathogens including C. jejuni, and its availability for use in children and pregnant women. In SE Asia, azithromycin is probably the current drug of choice for treatment of travelers’ diarrhea. Although azithromycin should work in prophylaxis, there are no data to guide dosing amounts or frequency of administration.

An ideal antimicrobial agent for the prevention of travelers’ diarrhea would be one that has excellent activity against enteric pathogens, is not absorbed (helping to guarantee an excellent safety profile), is safe, has little potential for promoting antibiotic resistance, and has no other uses than in enteric diseases.1 Rifaximin is just such an agent, which has now been approved for treatment of travelers’ diarrhea when invasive pathogens are not suspected.25–27 It has exclusively intraluminal action with <0.4% gastrointestinal absorption, documented low potential for generating cross-resistance, and a profile of clinical use that is limited to GI syndromes and preventing hepatic encephalopathy. Rifaximin has also been shown to be effective in prevention of travelers’ diarrhea and affords 60–70% protection with a single daily 200 mg dose.28 Fecal levels are about 8000 µg/g of stool after 3 days of therapy, which far exceeds the average MIC (32–50 µg/mL) of enteric pathogens.25 The availability of such an agent permits consideration of a change in paradigm. The objections of the consensus development conference appear to be largely moot with the availability of rifaximin, although disagreement in general with the concept of chemoprophylaxis will likely continue to exist among some experts.29 Arguably, chemoprophylaxis with an agent such as rifaximin might now be offered to many short-term travelers rather than only those with special risks.

Pepto-Bismol

Pepto-Bismol is the brand name of bismuth subsalicylate, which is used to treat several stomach conditions, including diarrhea, gas, heartburn (acid reflux/GERD), nausea, and stomach discomfort.

Pepto-Bismol belongs to a class of drugs called antidiarrheals, which are used to relieve diarrhea and related symptoms.

While it is still unclear exactly how bismuth subsalicylate works to combat diarrhea, the chemical element bismuth is thought to have some antibiotic activity, while the salicylate portion is believed to have an antacid effect.

Pepto-Bismol Warnings

You should avoid taking Pepto-Bismol if you are taking any of the following drugs:

  • Carbonic anhydrase inhibitors like Diamox (acetazolamide) and methazolamide
  • Medications for gout, like Alloprim or Zyloprim (allopurinol), Uloric (febuxostat), and Krystexxa (pegloticase)

If you are allergic to Pepto-Bismol, salicylates, or related products, you should not take Pepto-Bismol.

Talk to your pharmacist or doctor about drug allergies if you have a concern before taking this or any other medication.

Pepto-Bismol and Pregnancy

Pepto-Bismol could possibly cause harm to a fetus.

Pregnant women who have passed their twentieth week of pregnancy should avoid taking Pepto-Bismol.

Regardless, you should tell your doctor if you are pregnant or plan to become pregnant before taking this medication.

You should also alert your physician if you are breastfeeding or plan to breastfeed.

It’s not recommended that breastfeeding mothers take this medication.

Pepto-Bismol and Children

Because Pepto-Bismol contains an active ingredient in the salicylate family, you should avoid giving it to children or teenagers if they have the chicken pox or the flu virus.

You should also avoid giving your child this medication if he or she has received the chicken pox vaccine within the last six weeks.

This is because medications that either contain or are related to salicylates can cause a condition known as Reyes’ syndrome.

Pepto-Bismol for Dogs and Cats

Pepto-Bismol is not considered safe for cats and should only be administered by a veterinarian in cases where it might be medically necessary.

However, Pepto-Bismol can be given to dogs to treat diarrhea and stomach discomfort.

If your dog has problems with bleeding or is taking medications that can thin the blood (like non-steroidal anti-inflammatory drugs, or NSAIDs), you should be very careful when giving your dog Pepto-Bismol.

In those cases, it’s probably a good idea to ask your veterinarian first before giving your dog Pepto-Bismol.

Generic Name: bismuth subsalicylate (BIZ muth sub sa LISS i late)
Brand Name: Bismarex, Bismatrol, Bismatrol Maximum Strength, Kaopectate, Kola-Pectin DS, Peptic Relief, Pepto-Bismol, Pink Bismuth

Medically reviewed by Drugs.com on Nov 21, 2019 – Written by Cerner Multum

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What is Pepto-Bismol?

Pepto-Bismol is used to treat diarrhea, nausea, heartburn, indigestion, gas, or upset stomach.

Pepto-Bismol may also be used for purposes not listed in this medication guide.

Important Information

You should not use Pepto-Bismol if you have bleeding problems, a stomach ulcer, blood in your stools, or if you are allergic to aspirin or other salicylates.

Do not give this medicine to a child or teenager with a fever, flu symptoms, or chickenpox.

Before taking this medicine

You should not use Pepto-Bismol if you are allergic to it, or if you have:

  • black or bloody stools;

  • a stomach ulcer;

  • bleeding problems; or

  • if you are allergic to salicylates such as aspirin, Doan’s Extra Strength, Salflex, Tricosal, and others.

Do not give this medicine to a child or teenager with a fever, flu symptoms, or chickenpox. Salicylates can cause Reye’s syndrome, a serious and sometimes fatal condition in children.

Ask a doctor or pharmacist if this medicine is safe to use if you have:

  • mucus in your stools; or

  • if you currently have a fever.

Ask a doctor before using this medicine if you are pregnant or breastfeeding.

Do not give this medicine to a child younger than 12 years old without medical advice.

How should I take Pepto-Bismol?

Use exactly as directed on the label, or as prescribed by your doctor.

Shake the oral suspension (liquid) before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

You must chew the chewable tablet before you swallow it.

Drink plenty of liquids while you are taking Pepto-Bismol.

Do not take more than 8 doses in one day (24 hours).

Call your doctor if you still have diarrhea after 2 days of using Pepto-Bismol.

This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using Pepto-Bismol.

Store at room temperature away from moisture and heat. Do not freeze.

What happens if I miss a dose?

Since Pepto-Bismol is used when needed, you may not be on a dosing schedule. Skip any missed dose if it’s almost time for your next dose. Do not use two doses at one time.

Do not take more than 8 doses per day.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include weakness, depression, anxiety, feeling irritable, problems with balance or coordination, confusion, tremors, or jerky muscle movements.

What should I avoid while taking Pepto-Bismol?

Ask a doctor or pharmacist before taking other antacids or diarrhea medicine, or taking medicine that may contain a salicylate (such as aspirin, salsalate, magnesium salicylate, choline salicylate, diflunisal, Ecotrin, Tricosal, Trilisate, and others).

Pepto-Bismol side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop taking Pepto-Bismol and call your doctor at once if you have:

  • changes in behavior with nausea and vomiting;

  • hearing loss or ringing in your ears;

  • diarrhea lasting longer than 2 days; or

  • worsened stomach symptoms.

Pepto-Bismol can cause you to have a black or darkened tongue. This is a harmless side effect.

Common side effects include:

  • constipation; or

  • dark colored stools.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Pepto-Bismol?

Ask a doctor or pharmacist before using Pepto-Bismol with any other medications, especially:

  • arthritis medicine;

  • gout medicine;

  • insulin or oral diabetes medications; or

  • a blood thinner–warfarin, Coumadin, Jantoven.

This list is not complete. Other drugs may affect Pepto-Bismol, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2018 Cerner Multum, Inc. Version: 4.01.

Related questions

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  • How to stop diarrhea – any medicine or remedy suggestions?

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  • Pepto-Bismol (Bismuth Subsalicylate Tablets)
  • Pepto Bismol (Advanced Reading)

Other brands: Kaopectate, Bismatrol, Pink Bismuth, Kapectolin (New Formula), … +4 more

Professional resources

  • Bismuth Subsalicylate Suspension (FDA)

Related treatment guides

  • Lymphocytic Colitis
  • Helicobacter Pylori Infection
  • Indigestion
  • Diarrhea
  • Diarrhea, Chronic
  • Traveler’s Diarrhea

Pepto-Bismol for Prevention?

Q: I’ve heard that Pepto-Bismol can be taken to prevent traveler’s diarrhea, not just to treat it. Should I try this?

A: It’s something worth considering if you are traveling to a developing country, especially if you have a history of traveler’s diarrhea or are at risk from complications due to a medical condition you have. But talk with your health care provider first, since there are some caveats and contraindications.

The active ingredient in Pepto-Bismol is bismuth subsalicylate (BSS, available also generically), which has antimicrobial and anti-inflammatory effects. The typical recommendation is to take two tablets with each meal and two at bedtime (a total daily dose of 8 tablets), starting with the first meal at your destination and ending with your last meal (to be extra safe, you can take one more dose after that, which might be on the plane home). This has been shown to reduce the risk of traveler’s diarrhea by up to 65 percent. Chewable tablets or caplets (as opposed to liquid versions) are most convenient for traveling.

A harmless and temporary side effect is darkening of stool and the tongue. To prevent your tongue turning black, rinse your mouth thoroughly after chewing the tablets or, better yet, gently brush your tongue, especially after the nighttime dose. A problem with having black stools is that this could indicate gastrointestinal bleeding, something that a number of travel-related diseases produce, so taking BSS could interfere with its detection.

Other potential side effects include constipation (which some people might consider worse than getting diarrhea) and, rarely, mild and transient tinnitus (ringing in the ears), which can also happen with aspirin, another salicylate drug.

Other things to be aware of before popping these pink pills:

  • It’s generally cautioned that BSS not be taken longer than three or four weeks because there have been a few reported cases of bismuth toxicity, characterized by tremors and other neurological symptoms. A study from 1990 found that taking 12 tablets a day for 6 weeks did not have toxic effects, however. In any case, most people don’t travel long enough for bismuth toxicity to be a concern. Of greater concern is salicylate toxicity in people who concomitantly take BSS and aspirin—or who take it while also over-applying salicylate-containing liniments, such as Bengay (in the oil of wintergreen). The amount of salicylates you absorb from 8 tablets of BSS is equivalent to that of 3 or 4 adult aspirins.
  • BSS can interact with many drugs, including doxycycline, which, depending on your destination, may be recommended for malaria prevention. If you take both doxycycline and BSS on your travels, you should take them a few hours apart.
  • People with certain medical conditions, including (but not limited to) inflammatory bowel disease, should not take BSS. Children under 3 should not take BSS. Consult your doctor before giving it to children between the ages of 3 and 12. It should not be taken by anyone who is allergic or sensitive to aspirin.
  • BSS is not a substitute for being careful about what and where you eat and drink when you travel to developing countries. You should still generally avoid tap water (and even bottled water without a proper seal), unpeeled raw fruits and vegetables, salads, unpasteurized dairy foods, undercooked meats and shellfish, and street foods.
  • Rather than recommend BSS prophylactically, some doctors advise that travelers bring the anti-diarrheal drug loperamide (available by prescription or over the counter, as in Immodium) and antibiotics with them to use only if they become very sick.

The History of Pepto

Over 100 Years of Pepto History

Pepto-Bismol provides effective relief of multiple stomach symptoms. Available in liquid, chewable tablets, and swallowable caplets, Pepto-Bismol treats diarrhea and provides fast relief of upset stomach, nausea, heartburn, and indigestion due to overindulgence in food and drink.

The formula of the pink medicine we now call Pepto-Bismol was originally developed at the start of the 20th century, when high standards of hygiene and sanitation weren’t as widespread as today. Looking to cure a frightening form of cholera that caused severe diarrhea, vomiting, and sometimes death, a doctor concocted a formula in his home that proved effective against these symptoms. The formula (which was different from today’s) was made from pepsin, zinc salts, salol, and oil of wintergreen, along with a colorant to make it pink, and he called it Mixture Cholera Infantum. (Researchers would later learn that this illness was caused by a bacterial infection, treatable with antibiotics.)

Today, we think of how Pepto-Bismol soothes the digestive system after we’ve overindulged at a meal. Or, we think of it as a travel companion that can help soothe stomach upsets associated with traveler’s diarrhea. But in its early days, a different form of Pepto-Bismol did more than comfort; it actually helped treat symptoms of a more serious illness.

Sharing with the World

The invention of what we now know as Pepto-Bismol coincided with other health advances, such as milk pasteurization and public campaigns advocating hand washing.

The early success of Pepto-Bismol presented a production crisis for its inventor, who couldn’t make enough product in his home to satisfy demand. He brought his formula to what was then called the Norwich Pharmacal Company in Norwich, New York. Norwich Pharmacal had a way to increaseproduction dramatically – by manufacturing it in 20-gallon tubs.

Norwich added the remedy to its catalog for medical professionals, with the product name Bismosal: Mixture Cholera Infantum. Norwich tinkered with the doctor’s formula a bit and advertised the improved product as an “elegant, pleasantly flavored” mixture.

How does this medication work? What will it do for me?

Bismuth subsalicylate belongs to a class of medications called antacids and adsorbents. It is used to help relieve heartburn, indigestion, upset stomach, nausea, and diarrhea. How bismuth subsalicylate works is not completely understood, but it is thought to work by coating the stomach and intestines (protecting them from stomach acid), by reducing inflammation in the stomach, and by killing certain bacteria.

Bismuth subsalicylate has also been used to prevent travelers’ diarrhea and along with antibiotics to treat ulcers believed to be caused by the bacteria H. pylori. In both cases, other treatments are generally more effective.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor or pharmacist has not recommended it.

What form(s) does this medication come in?

Chewable Tablets
Each peppermint-flavoured chewable tablet contains bismuth subsalicylate 262 mg. Nonmedicinal ingredients: calcium carbonate, magnesium stearate, mannitol, peppermint flavour, PVP, Red 27 Lake, sodium saccharin, and talc.

Caplets
Each caplet contains bismuth subsalicylate 262 mg. Nonmedicinal ingredients: calcium carbonate, magnesium stearate, mannitol, microcrystalline cellulose, polysorbate 80, PVP, Red 27 Lake, silica, and sodium carboxymethyl starch.

Liquid

Original
Each mL contains bismuth subsalicylate 17.6 mg. Nonmedicinal ingredients: benzoic acid, D&C Red No. 22, D&C Red No. 28, flavour, magnesium aluminum silicate, methylcellulose, sodium saccharin, salicylic acid, sodium salicylate, sorbic acid, and water.

Cherry-Flavoured
Each mL contains bismuth subsalicylate 17.6 mg. Nonmedicinal ingredients: benzoic acid, D&C Red No. 22, D&C Red No. 28, flavour, magnesium aluminum silicate, methylcellulose, sodium saccharin, salicylic acid, sodium salicylate, sorbic acid, sucralose, and water.

Liquid Extra Strength

Original
Each mL contains bismuth subsalicylate 35.2 mg. Nonmedicinal ingredients: benzoic acid, D&C Red No. 22, D&C Red No. 28, flavour, magnesium aluminum silicate, methylcellulose, sodium saccharin, salicylic acid, sodium salicylate, sorbic acid, and water.

Cherry-Flavoured
Each mL contains bismuth subsalicylate 35.2 mg. Nonmedicinal ingredients: benzoic acid, D&C Red No. 22, D&C Red No. 28, flavour, magnesium aluminum silicate, methylcellulose, sodium saccharin, salicylic acid, sodium salicylate, sorbic acid, sucralose, and water.

How should I use this medication?

Caplets: The usual recommended dose for adults is 525 mg (2 caplets) every 30 minutes as needed, up to a maximum of 16 caplets in 24 hours. For children 10 to 12 years of age, the usual dose is 262 mg (1 caplet) every 30 minutes as needed, up to a maximum of 8 caplets in 24 hours. Children 2 to 9 years of age should use the liquid form of this medication.

Liquid: The usual dose for adults is 2 tablespoons (30 mL). For children 10 to 12 years of age, the usual dose is 1 tablespoon (15 mL). For children 5 to 9 years of age, the usual dose is 1½ teaspoons (7.5 mL). For children 2 to 4 years of age, the recommended dose is 1 teaspoon (5 mL). The recommended dose can be given every 30 minutes to a maximum of 8 doses in 24 hours for the regular-strength liquid, and 4 doses in 24 hours for the extra-strength liquid.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Shake the liquid well before use. To measure the dose correctly, use a medication measuring cup or oral syringe. Household teaspoons and tablespoons do not provide accurate dosing.

It is important to take this medication exactly as recommended by your doctor or pharmacist. This medication is often taken on an “as needed” schedule, however your doctor or pharmacist may recommend that you take it regularly. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use this medication if you:

  • are allergic to bismuth subsalicylate or any ingredients of the medication
  • are allergic to other salicylate products (e.g., ASA)
  • have a bleeding problem
  • have a stomach or intestinal ulcer
  • have bloody or black stools

Do not give this medication to children or adolescents with flu-like symptoms or chickenpox.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • dark tongue
  • grey or dark stools

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • anxiety
  • muscle spasms
  • muscle weakness
  • severe constipation

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • symptoms of a severe allergic reaction (hives, swelling of the mouth or throat, difficulty breathing)
  • symptoms of taking too much of this medication (seizures, extreme drowsiness, fast breathing, ringing in the ears, confusion, hearing loss)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Bleeding problems: Bismuth subsalicylate should not be used without a doctor’s recommendation if you have ulcers, bleeding disorders or bloody or black stools.

Diabetes: Salicylate medications can cause decreased blood glucose control. If you have diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Diarrhea: If you have mucus in your diarrhea or if you also have a fever, contact your doctor before using this medication. Diarrhea can cause dehydration, so ensure you are drinking enough fluids (e.g., oral rehydration solution). If you experience symptoms of dehydration (e.g., dry mouth, excessive thirst, decreased urine production, dizziness, lightheadedness), contact your doctor.

If you have diarrhea that lasts more than 2 days or your symptoms get worse, contact your doctor.

Gout: Salicylate medications can make symptoms of gout worse or cause an attack of gout. If you have gout, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Bismuth subsalicylate can build up in the body when the liver is not working properly. If you have reduced liver function or liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Reye’s syndrome: Children and adolescents who have or are recovering from chickenpox or other flu-like symptoms should not use this medication as it may cause Reye’s syndrome, a rare but serious condition. If you notice behavior changes along with nausea and vomiting in your child after treating with bismuth subsalicylate, contact your doctor immediately.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if bismuth subsalicylate passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children less than 2 years of age.

What other drugs could interact with this medication?

There may be an interaction between bismuth subsalicylate and any of the following:

  • insulin
  • methotrexate
  • omeprazole
  • oral medications used to treat diabetes (e.g., glyburide, gliclazide)
  • other salicylate medications (e.g., ASA)
  • probenecid
  • sulfinpyrazone
  • tetracycline antibiotics (e.g., doxycycline, minocycline, tetracycline)
  • warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Pepto-Bismol

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