BIZ-muth sub-sa-LIS-i-late

Therapeutic Classification: antidiarrheals, antiulcer agents

Pharmacologic Classification: adsorbents

• Mild to moderate diarrhea.
• Nausea, abdominal cramping, heartburn, and indigestion that may accompany diarrheal illnesses.
• Treatment of ulcer disease associated with Helicobacter pylori (with anti-infectives).
• Treatment/prevention of traveler’s (enterotoxigenic Escherichia coli) diarrhea.

• Promotes intestinal adsorption of fluids and electrolytes.
• Decreases synthesis of intestinal prostaglandins.

• Relief of diarrhea.
• Eradication of H. pylori with decreased recurrence of ulcer disease (with other agents).

Absorption: Bismuth is not absorbed; salicylate split from parent compound is >90% absorbed from the small intestine.

Distribution: Salicylate is well distributed to tissues.

Protein Binding: Bismuth and salicylate >90%.

Metabolism/Excretion: Bismuth is excreted unchanged in the feces. Salicylate undergoes extensive hepatic metabolism.

Half-life: Salicylate — 2–3 hr for low doses; 15–30 hr with larger doses.

(relief of diarrhea and other GI symptoms)

Contraindicated in:

• Aspirin hypersensitivity; cross-sensitivity with NSAIDs or oil of wintergreen may occur;Pedi: During or after recovery from chickenpox or flu-like illness (contains salicylate, which can cause Reye syndrome)
• OB: Pregnancy
• Lactation: Lactation.

Use Cautiously in:

• Patients undergoing radiologic examination of the GI tract (bismuth is radiopaque)
• Diabetes mellitus
• Gout
• Pedi: Geri: Potential for impaction in children and older adults.

GI: constipation, gray-black stools/tongue, impaction (infants, debilitated patients).

Drug-Drug:

• If 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).

• PO (Adults): Antidiarrheal: 2 tablets or 30 mL (15 mL of extra/maximum strength) every 30 min or 2 tablets every 60 min as needed (not to exceed 4.2 g/24 hr). Antiulcer: 524 mg 4 times daily (as 2 tablets, 30 mL of regular strength suspension or 15 mL of extra/maximum strength).
• PO (Children 9–12 yr): 1 tablet or 15 mL (7.5 mL of extra/maximum strength) every 30–60 min (not to exceed 2.1 g/24 hr).
• PO (Children 6–9 yr): 10 mL (5 mL of extra/maximum strength) every 30–60 min (not to exceed 1.4 g/24 hr).
• PO (Children 3–6 yr): 5 mL (2.5 mL of extra/maximum strength) every 30–60 min (not to exceed 704 mg/24 hr).

(Generic available)

• Tablets: 262 mg^OTC;
• Chewable tablets (cherry and other flavors): 262 mg^OTC;
• Liquid (cherry, caramel, peppermint, and other flavors): 262 mg/15 mL^OTC; 525 mg/15 mL^OTC;
• In combination with: metronidazole and tetracycline (Pylera — combination capsule). See Appendix [not included in this PDA edition].

• 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.

• 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.

• PO: 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 syndrome.
• Ulcers: Advise patient to consult health care professional before taking other OTC ulcer remedies concurrently with bismuth subsalicylate.
• Avoid bismuth subsalicylate during pregnancy and breastfeeding.

• Decrease in diarrhea.
• Decrease in symptoms of indigestion.
• Prevention of traveler’s diarrhea.
• Treatment of ulcers.

Bismatrol, Peptic Relief, Pepto-Bismol