III. Contraindications: Bismuth Subsalicylate

  1. Salicylate allergy
  2. Concurrent use with other Salicylates OR Warfarin (relative contraindication)
  3. Children and teens (relative contraindication)
    1. Due to Reye's Syndrome risk
    2. Avoid especially with febrile illness, Varicella Zoster Virus or Influenza
  4. Do not exceed 3 weeks of use (or 2 days of use for Acute Diarrhea)

IV. Mechanism

  1. Bismuth salt of salicylic acid with minimal gastrointestinal absorption
  2. Protects gastric mucosa from local acid and pepsin corrosive effects
  3. Antimicrobial activity

V. Preparations

  1. Bismuth Subsalicylate (Original Pepto-Bismol)
    1. Chewable Tablets 262 mg
    2. Suspension 262 mg/15 ml
    3. Caplets 262 mg
  2. Calcium Carbonate
    1. Children's Pepto-Bismol

VI. Dosing: Acute Diarrhea

  1. Tablet: Two tabs orally four times daily up to maximum of every 4 hours
  2. Adult
    1. Take 2 tablets or 30 ml every 30 to 60 minutes as needed
    2. Maximum of 8 doses/day (240 ml/day) and up to 2 days
  3. Child
    1. Give 100 mg/kg/day divided in 5 doses for up to 2 days
    2. Age 3 to 6 years old
      1. Give 1/3 of a 262 mg chewable tablet every 30 to 60 min up to 8 doses/day OR
      2. Give 5 ml of 262 mg/15 ml suspension every 30 to 60 min up to 8 doses/day
    3. Age 7 to 9 years old
      1. Give 2/3 of a 262 mg chewable tablet every 30 to 60 min up to 8 doses/day OR
      2. Give10 ml of 262 mg/15 ml suspension every 30 to 60 min up to 8 doses/day
    4. Age 10 to 12 years old
      1. Give 1 of a 262 mg chewable tablet every 30 to 60 min up to 8 doses/day OR
      2. Give 15 ml of 262 mg/15 ml suspension every 30 to 60 min up to 8 doses/day

VII. Dosing: Chronic Infant Diarrhea

  1. Age 2 to 24 months (up to age 2): Give 2.5 ml of 262 mg/15 ml suspension orally every 4 hours as needed
  2. Age 25 to 48 months (up to age 4): Give 5 ml of 262 mg/15 ml suspension orally every 4 hours as needed
  3. Age 49 to 70 months (>age 4 years): Give 10 ml of 262 mg/15 ml suspension orally every 4 hours as needed

VIII. Dosing: Traveler's Diarrhea Prevention

  1. Adult
    1. Take 2 tabs four times daily before meals and at bedtime (2.1 grams/day)

IX. Safety

  1. Pregnancy Category C
  2. Avoid in Lactation

X. Adverse Effects

  1. See Salicylates
  2. Turns Tongue and stool black
  3. Mild Tinnitus

XI. Drug Interactions

  1. May potentiate other medications
    1. Oral Anticoagulants
    2. Hypoglycemic agents
  2. Decreases effect of other drugs
    1. Uricosurics (Probenecid, Sulfinpryazone)
    2. Tetracyclines
      1. May decrease Bioavailability of Doxycycline, Tetracycline
      2. Doxycycline is used for Malaria Prophylaxis

XIII. References

  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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