bismuth subsalicylate
Bismatrol, Pepto-Bismol

Available forms
Available without a prescription
Caplets: 262 mg
Suspension: 130 mg/15 ml, 262 mg/15 ml, 524 mg/ 15 ml
Tablets (chewable): 262 mg

Indications and dosages
 Mild, nonspecific diarrhea. Adults: 30 ml or two tablets P.O. q 30 to 60 minutes up to a maximum of eight doses and for no longer than 2 days.
Children ages 9 to 12: 15 ml or one tablet P.O.
Children ages 6 to 9: 10 ml or 2/3 tablet P.O.
Children ages 3 to 6: 5 ml or 1/3 tablet P.O.
 Children’s doses given q 30 to 60 minutes up to a maximum of eight doses in 24 hours and for no longer than 2 days.
 Prophylaxis of traveler’s diarrhea ◇. Adults: 2 tablets or 30 ml P.O. q.i.d. before meals and h.s. for up to 3 weeks during brief periods of high risk.

Pharmacodynamics
Antidiarrheal action: Bismuth adsorbs extra water in the bowel during diarrhea. It also adsorbs toxins and forms a protective coating for the intestinal mucosa.

Pharmacokinetics
Absorption: Absorbed poorly; significant salicylate absorption may occur after using bismuth subsalicylate.
Distribution: Distributed locally in the gut.
Metabolism: Metabolized minimally.
Excretion: Excreted in urine.

Contraindications and precautions
Contraindicated in patients hypersensitive to salicylates. Use cautiously in patients already taking aspirin or aspirin-containing medications.

Interactions
Drug-drug. Salicylates: Increase risk of aspirin toxicity. Monitor patient closely.
Sulfinpyrazone: Impairs uricosuric effect. Monitor patient for clinical effect.
Tetracycline: May impair tetracycline absorption. Separate administration times.

Adverse reactions
GI: temporary darkening of tongue and stools.
Other: salicylism (with high doses).

Effects on lab test results
None reported.

Overdose and treatment
Overdose hasn’t been reported. However, overdose is more likely with bismuth subsalicylate; probable clinical effects include CNS changes, such as tinnitus and fever.

Special considerations
• Because bismuth is radiopaque, it may interfere with radiologic examination of the GI tract.
• Bismuth subsalicylate has been used investigationally to treat peptic ulcer. Doses of 600 mg P.O. t.i.d. may be as effective as cimetidine 800 mg P.O. once daily.
• If giving drug by nasogastric tube, flush tube to clear it before giving drug to ensure delivery of drug to stomach; flush the tube afterward.
• If patient is also receiving tetracycline, administer drugs at least 1 hour apart; to avoid decreased drug absorption, dosages or schedules of other medications may need adjustment.
• Monitor hydration status and serum electrolyte levels, and record number and consistency of stools.
• Discontinue drug if patient develops tinnitus.
• Drug is useful for treating indigestion without causing constipation, nausea, flatulence, and abdominal cramps.
Breast-feeding patients
• Small amounts of drug appear in breast milk. Patient should seek medical approval before use.
Pediatric patients
• Don’t give drug to children or adolescents recovering from flu or chickenpox.

Patient education
• Advise patient taking anticoagulants or medication for diabetes or gout to seek medical approval before taking drug.
• As appropriate, instruct patient to chew tablets well or to shake suspension well before using.
• Tell patient to report persistent diarrhea.
• Warn patient that bismuth may temporarily darken stools and tongue.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use