bismuth subsalicylate

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Related to bismuth subsalicylate: metronidazole, Pepto Bismol


 (Bi) [biz´muth]
a chemical element, atomic number 83, atomic weight 208.980. (See Appendix 6.) Its salts have been used for their antacid and mild astringent properties in relief of inflammatory diseases of the stomach and intestines, and as topical protectants in skin and anorectal disorders.
bismuth subsalicylate a bismuth salt of salicylic acid, administered orally in the treatment of diarrhea and gastric distress, including nausea, indigestion, and heartburn.

bismuth subsalicylate

Bismatrol, Bismatrol Maximum Strength, Diotame, Kao-Tin, Kaopectate, Kaopectate Extra Strength, Kapectolin, Maalox Total Stomach Relief, Pepto-Bismol, Pepto-Bismol Bismuth Maximum Strength, Pink Bismuth

Pharmacologic class: Adsorbent

Therapeutic class: Antidiarrheal, antibiotic, antiulcer drug

Pregnancy risk category C


Promotes intestinal adsorption of fluids and electrolytes and decreases synthesis of intestinal prostaglandins. Adsorbent action removes irritants from stomach and soothes irritated bowel lining. Also shows antibacterial activity to eradicate Helicobacter pylori.


Liquid: 130 mg/15 ml, 262 mg/15 ml, 525 mg/15 ml (maximum strength)

Tablets: 262 mg

Tablets (chewable): 262 mg, 300 mg

Indications and dosages

Adjunctive therapy for mild to moderate diarrhea, nausea, abdominal cramping, heartburn, and indigestion accompanying diarrheal illnesses

Adults: Two tablets or 30 ml P.O. (15 ml of maximum strength) q 30 minutes, or two tablets or 60 ml (30 ml of extra/maximum strength) q 60 minutes as needed. Don't exceed 4.2 g in 24 hours.

Children ages 9 to 12: One tablet or 15 ml P.O. (7.5 ml of maximum strength) q 30 to 60 minutes. Don't exceed 2.1 g in 24 hours.

Children ages 6 to 9: 10 ml (5 ml of maximum strength) P.O. q 30 to 60 minutes. Don't exceed 1.4 g in 24 hours.

Children ages 3 to 6: 5 ml (2.5 ml of maximum strength) P.O. q 30 to 60 minutes. Don't exceed 704 mg in 24 hours.

Ulcer disease caused by H. pylori

Adults: Two tablets or 30 ml P.O. q.i.d. (15 ml of maximum strength)

Off-label uses

• Chronic infantile diarrhea

• Norwalk virus-induced gastroenteritis


• Hypersensitivity to aspirin

• Elderly patients with fecal impaction

• Children or adolescents during or after recovery from chickenpox or flulike illness


Use cautiously in:

• diabetes mellitus, gout

• patients taking concurrent aspirin

• elderly patients

• pregnant or breastfeeding patients

• infants.


• Know that tablets should be chewed or dissolved in mouth before swallowing.

• Be aware that drug is usually given with antibiotics (such as tetracycline or amoxicillin) when prescribed for ulcer disease.

Adverse reactions

EENT: tinnitus, tongue discoloration

GI: nausea, vomiting, diarrhea, constipation, gray-black stools, fecal impaction

Respiratory: tachypnea

Other: salicylate toxicity


Drug-drug. Aspirin, other salicylates: salicylate toxicity

Corticosteroids, probenecid (large doses),

sulfinpyrazone: decreased bismuth efficacy

Enoxacin: decreased enoxacin bioavailability

Methotrexate: increased risk of bismuth toxicity

Tetracycline: decreased tetracycline absorption

Drug-diagnostic tests. Radiologic GI tract examination: test interference

Patient monitoring

• Monitor fluid intake and electrolyte levels.

• Monitor stool frequency and appearance.

• Assess infants and debilitated patients for fecal impaction.

Patient teaching

• Instruct patient to chew tablets or dissolve them in mouth before swallowing.

• Inform patient that drug may turn stools gray-black temporarily.

• Tell patient to notify prescriber if he has diarrhea with fever for more than 48 hours.

• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

bismuth subsalicylate

(sŭb-sə-lĭs′ə-lāt′, -lĭt, -săl′ĭ-sĭl′ĭt)
A salicylate used to treat nausea, indigestion, and diarrhea.

bismuth subsalicylate

a bismuth salt of salicylic acid, administered orally in the treatment of diarrhea and gastric distress, including nausea, indigestion, and heartburn.

bismuth subsalicylate

An insoluble basic salt containing 58% bismuth by weight, which is used to manage GI tract disease (diarrhoea, heartburn, indigestion, nausea), and Helicobacter pylori-induced peptic ulcer disease.

Adverse effects
Black tongue, black stool, salicylism (i.e., contraindicated in children, given the risk of Reye syndrome).

Mechanism of action
Unknown, possibly antimicrobial—prevents attachment of microorganisms, inactivates enterotoxins, inhibits rotavirus replication, antisecretory, anti-inflammatory; in children with watery diarrhoea, BS therapy (100–150 mg/kg/d), reduces stool output, reduces oral rehydration requirements and reduces the need for hospitalisation
References in periodicals archive ?
Worldwide efficacy of bismuth subsalicylate in the treatment of travelers' diarrhea.
0008 BMT = bismuth subsalicylate, metronidazole 250-mg tablet, tetracycline 500-mg tablet plus cimetidine 400-mg tablet LAC = lansoprazole 30-mg tablet, amoxicillin 1000-mg tablet, and clarithromycin 500-mg tablet Table 2.
Bismuth subsalicylate also may be used as treatment: 1 fluid ounce or 2 262 mg tablets every 30 minutes for up to eight doses in a 24-hour period, which can be repeated on a second day.
pylori is a 2-week, triple therapy of metronidazole, tetracycline or amoxicillin, and bismuth subsalicylate.
Although this regimen decreases the number of stools and increases their consistency, the beneficial activity of bismuth subsalicylate is somewhat slower than that of antimolility drugs.
That study concluded that bismuth subsalicylate is "a safe adjunct to oral rehydration therapy for infants and young children with watery diarrhea.
metronidazole, or clarithromycin, plus either ranitidine bismuth citrate, bismuth subsalicylate, or a proton pump inhibitor.
Late last year it rolled out Helidac Therapy, an ulcer medication that combines bismuth subsalicylate, metronidazole and tetracycline hydrochloride.
Doctors in Peru evaluated the potential benefits of adding bismuth subsalicylate (Pepto-Bismal and other products) in treating infantile diarrhea.
Bismuth subsalicylate (Pepto Bismol) may decrease the chances of getting TD, but carrying enough in one's luggage may not seem worth the effort.
pylori eradication than quadruple therapy with bismuth subsalicylate, tetracycline, metronidazole, and a proton-pump inhibitor.
PPI + bismuth subsalicylate 525 mg + metronidazole 500 mg 3 times daily + tetra-cycline 500 mg 4 times daily