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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(sŭb-sə-lĭs′ə-lāt′, -lĭt, -săl′ĭ-sĭl′ĭt)
bismuth subsalicylateAn 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.
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