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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)
• 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
• 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.
EENT: tinnitus, tongue discoloration
GI: nausea, vomiting, diarrhea, constipation, gray-black stools, fecal impaction
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
• Monitor fluid intake and electrolyte levels.
• Monitor stool frequency and appearance.
• Assess infants and debilitated patients for fecal impaction.
• 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(biz-muth sub-sa-lis-i-late ) ,
Peptic Relief(trade name),
Time/action profile (relief of diarrhea and other GI symptoms)
|PO||within 24 hr||unknown||unknown|
Adverse Reactions/Side Effects
- gray-black stools
- impaction (infants, debilitated patients)
Drug-Drug interactionIf taken with aspirin, may ↑ the risk of salicylate toxicity.May ↓ absorption of tetracycline or fluoroquinolones (separate administration by 2–4 hr).May ↓ effectiveness of probenecid (large doses).
Availability (generic available)
- Diarrhea: Assess the frequency and consistency of stools, presence of nausea and indigestion, and bowel sounds before and during therapy.
- Assess fluid and electrolyte balance and skin turgor for dehydration if diarrhea is prolonged.
- Ulcers: Assess for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate.
- Lab Test Considerations: Chronic high doses may cause falsely ↑ uric acid levels with colorimetric assay.
- May interfere with radiologic examination of the GI tract.
- May cause abnormal results with alkaline phosphatase, AST, and ALT tests.
- May cause ↓ potassium levels and serum T3 and T4 concentrations.
- Large doses of salicylates may also cause prolonged prothrombin time (PT).
- For additional lab test considerations related to salicylate content, see salicylates monograph.
Potential Nursing DiagnosesDiarrhea (Indications)
Constipation (Side Effects)
- Do not confuse Kaopectate (bismuth subsalicylate) with Kaopectate Stool Softener (docusate calcium).
- Oral: Shake liquid before using. Chewable tablets may be chewed or allowed to dissolve before swallowing.
- Instruct patient to take medication exactly as directed.
- Inform patient that medication may temporarily cause stools and tongue to appear gray-black.
- Instruct patient that this medication contains aspirin. Advise patient taking concurrent aspirin products to discontinue bismuth subsalicylate if tinnitus, ringing in the ears, occurs.
- Diarrhea: Instruct patient to notify health care professional if diarrhea persists for more than 2 days or if accompanied by a high fever.
- U.S. Centers for Disease Control and Prevention warn against giving salicylates to children or adolescents with varicella (chickenpox) or influenza-like or viral illnesses because of a possible association with Reye’s syndrome.
- Ulcers: Advise patient to consult health care professional before taking other OTC ulcer remedies concurrently with bismuth subsalicylate.
- Decrease in diarrhea.
- Decrease in symptoms of indigestion.
- Prevention of traveler’s diarrhea.
- Treatment of ulcers.