bismuth subsalicylate

REMS

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.

Contraind./Precautions ⬆ ⬇

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: Potential for impaction in children and older adults.

Adv. Reactions/Side Effects ⬆ ⬇

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

Interactions ⬆ ⬇

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).

Availability ⬆ ⬇

(Generic available)

Tablets: 262 mg^OTC
Chewable tabletscherry and other flavors: 262 mg^OTC
Liquidcherry, 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].

Route/Dosage ⬆ ⬇

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).

US Brand Names ⬆ ⬇

Bismatrol, Peptic Relief, Pepto-Bismol

Action ⬆ ⬇

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

Therapeutic effects:

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

Classifications ⬆ ⬇

Therapeutic Classification: antidiarrheals, antiulcer agents

Pharmacologic Classification: adsorbents

Pharmacokinetics ⬆ ⬇

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.

Time/Action Profile ⬆ ⬇

(relief of diarrhea and other GI symptoms)

ROUTE	ONSET	PEAK	DURATION
PO	within 24 hr	unknown	unknown

Patient/Family Teaching ⬆ ⬇

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.
Rep: Avoid bismuth subsalicylate during pregnancy and breastfeeding.

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Indications ⬇