Bismuth Subsalicylate: Uses, Dosage, and Safety Information

Summary of Key Points

Bismuth subsalicylate is an over-the-counter medication commonly used to address various digestive issues, such as diarrhea, nausea, indigestion, heartburn, and upset stomach. It is also effective in managing traveler’s diarrhea and infections like *H. pylori*. Available in both liquid and tablet forms, it works by protecting the stomach lining and reducing inflammation. Always consult your healthcare provider before starting or adjusting your dose.

Names of Medication

US Brand Name: Pepto-Bismol (Bismuth subsalicylate)

Other Brand Name: Kaopectate (Bismuth subsalicylate)

The generic name refers to the active ingredient in the medication, while the brand name is the name given by the manufacturer. In this case, the generic name is Bismuth subsalicylate, which is the active ingredient in both Pepto-Bismol and Kaopectate.

Pharmacologic Category

Categories:

1. Antidiarrheal
2. Antacid
3. Gastrointestinal agent

Bismuth Subsalicylate Dosage

Bismuth subsalicylate is prescribed for several conditions. Below are the recommended doses for adults. Always consult your healthcare provider before changing your dose or starting a new treatment. You can also schedule a telemedicine appointment with one of our providers for personalized advice.

Bismuth Subsalicylate for Diarrhea

For acute diarrhea, take 524 mg (two tablespoons of liquid or two tablets) every 30 to 60 minutes as needed. Do not exceed 8 doses (4,192 mg) in 24 hours. Treatment should not continue for more than 2 days without consulting a healthcare provider.

Bismuth Subsalicylate for Nausea, Indigestion, Heartburn, and Upset Stomach

Take 524 mg every 30 to 60 minutes as needed. Do not exceed 8 doses in 24 hours. If symptoms persist for more than 2 days, consult your healthcare provider.

Bismuth Subsalicylate for Traveler’s Diarrhea

Take 524 mg every 30 to 60 minutes as needed. Do not exceed 8 doses in 24 hours. Treatment should not last more than 2 days without consulting a healthcare provider.

Bismuth Subsalicylate for Gastroenteritis

Take 524 mg every 30 to 60 minutes as needed. Do not exceed 8 doses in 24 hours. If symptoms persist, consult your healthcare provider.

Bismuth Subsalicylate for Peptic Ulcers and H. pylori Infection

For peptic ulcers caused by *H. pylori* infection, Bismuth subsalicylate is often used as part of combination therapy. The typical dose is 524 mg four times daily for 10 to 14 days. Always follow your healthcare provider’s instructions for combination therapy.

Bismuth Subsalicylate for Dyspepsia (Indigestion)

Take 524 mg every 30 to 60 minutes as needed. Do not exceed 8 doses in 24 hours. If symptoms persist for more than 2 days, consult your healthcare provider.

Dosage Forms and Strengths

Bismuth subsalicylate is available in the following forms and strengths:

1. Liquid: 262 mg/15 mL, 525 mg/15 mL
2. Chewable Tablets: 262 mg
3. Caplets: 262 mg

Contraindications for Bismuth Subsalicylate

A contraindication is a specific situation or condition in which a medication should not be used because it may cause harm. If you have any of the conditions listed below, you should avoid taking Bismuth subsalicylate. Always consult with your healthcare provider before starting or stopping any medication, especially if you have any of these conditions.

1. Allergy to salicylates (e.g., aspirin): Bismuth subsalicylate contains salicylate, which is similar to aspirin. If you are allergic to aspirin or other salicylates, taking this medication could trigger an allergic reaction, which may include symptoms like rash, swelling, or difficulty breathing.
2. Active gastrointestinal bleeding: If you have a bleeding ulcer or any other form of active gastrointestinal bleeding, Bismuth subsalicylate can worsen the bleeding due to its salicylate content, which can interfere with blood clotting.
3. Children or teenagers with viral infections: Bismuth subsalicylate should not be given to children or teenagers recovering from viral infections, such as the flu or chickenpox, due to the risk of Reye’s syndrome, a rare but serious condition that can cause liver and brain damage.
4. Pregnancy (especially third trimester): Bismuth subsalicylate is not recommended during pregnancy, particularly in the third trimester, because salicylates can affect the baby’s heart and blood flow.
5. Kidney disease: If you have kidney disease, your body may not be able to clear the salicylate component of Bismuth subsalicylate effectively, which could lead to toxicity.

Drug Interactions with Bismuth Subsalicylate

Some medications can interact with Bismuth subsalicylate, potentially leading to harmful effects or reducing the effectiveness of either medication. If you are taking any of the following medications, talk to your healthcare provider before using Bismuth subsalicylate:

1. Blood thinners (e.g., warfarin, Coumadin): Bismuth subsalicylate can increase the risk of bleeding when taken with blood thinners.
2. Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen, Advil; naproxen, Aleve): Combining Bismuth subsalicylate with NSAIDs can increase the risk of gastrointestinal bleeding.
3. Diabetes medications (e.g., glipizide, Glucotrol): Bismuth subsalicylate may affect blood sugar levels, so it’s important to monitor your blood sugar closely if you take diabetes medications.
4. Antibiotics (e.g., tetracycline, doxycycline): Bismuth subsalicylate can interfere with the absorption of certain antibiotics, making them less effective.
5. Uricosuric agents (e.g., probenecid): These medications, used to treat gout, may be less effective when taken with Bismuth subsalicylate.

Bismuth Subsalicylate in Pregnancy

Is it safe to take Bismuth subsalicylate during pregnancy?

Bismuth subsalicylate, commonly known as Pepto-Bismol, is generally not recommended during pregnancy, especially in the third trimester. The salicylate component may affect the baby’s heart and blood circulation, and it can increase the risk of bleeding complications during delivery. If you’re pregnant and experiencing symptoms such as diarrhea or indigestion, it’s important to consult your healthcare provider for safer alternatives. You can also reach out to one of our telemedicine providers for immediate advice on managing your symptoms safely.

Bismuth Subsalicylate While Breastfeeding

Is it safe to take Bismuth subsalicylate while breastfeeding?

It is generally advised to avoid Bismuth subsalicylate while breastfeeding. Salicylates can pass into breast milk, potentially posing a risk to the baby, including the possibility of developing Reye’s syndrome. If you’re breastfeeding and need relief from symptoms like diarrhea or an upset stomach, consult your healthcare provider for safer alternatives. You can also speak with one of our telemedicine providers to discuss your symptoms and explore treatment options that are safe for both you and your baby.

Estimated Cost of Bismuth Subsalicylate

The cost of a 30-day supply of Bismuth subsalicylate can vary depending on the form (liquid or tablet) and dosage. With a GoodRx coupon, the estimated cost for a 30-day supply of generic Bismuth subsalicylate ranges from $5 to $10 without insurance. Prices may differ based on location and pharmacy, so it’s a good idea to compare options before making a purchase.

Possible Alternatives to Bismuth Subsalicylate

If Bismuth subsalicylate is not suitable for you, there are other treatment options and lifestyle changes that may help manage your symptoms. Always discuss these alternatives with your healthcare provider before making any changes to your treatment plan. You can also consult one of our telemedicine providers for personalized advice on alternatives to Bismuth subsalicylate.

Alternatives for Diarrhea

For diarrhea, alternatives include loperamide (Imodium) or probiotics. Staying hydrated and following a bland diet, such as the BRAT diet (bananas, rice, applesauce, and toast), can also help manage symptoms.

Alternatives for Nausea

For nausea, ginger supplements or peppermint tea may provide relief. Prescription medications like ondansetron (Zofran) may also be an option, depending on the severity of your symptoms.

Alternatives for Indigestion

For indigestion, antacids (e.g., Tums, Maalox) or H2 blockers (e.g., famotidine, Pepcid) can offer relief. Avoiding spicy or fatty foods may also help reduce indigestion symptoms.

Alternatives for Heartburn

For heartburn, proton pump inhibitors (PPIs) like omeprazole (Prilosec) or lifestyle changes, such as avoiding large meals and elevating the head of your bed, can help manage symptoms.

Alternatives for Upset Stomach

For an upset stomach, drinking clear fluids and avoiding greasy or spicy foods can be beneficial. Over-the-counter antacids may also provide relief from stomach discomfort.

Alternatives for Traveler’s Diarrhea

For traveler’s diarrhea, loperamide (Imodium) or antibiotics like ciprofloxacin may be prescribed. Staying hydrated and avoiding local water sources can help prevent symptoms while traveling.

Alternatives for Gastroenteritis

For gastroenteritis, staying hydrated is crucial. Oral rehydration solutions and a bland diet can help manage symptoms. In some cases, anti-nausea medications may be prescribed to alleviate discomfort.

Alternatives for Peptic Ulcers

For peptic ulcers, proton pump inhibitors (PPIs) like omeprazole (Prilosec) or H2 blockers like ranitidine (Zantac) are commonly used. Avoiding NSAIDs and managing stress may also help alleviate peptic ulcer symptoms.

Alternatives for H. Pylori Infection

For H. pylori infection, a combination of antibiotics and PPIs is often used to treat the condition. Completing the full course of treatment is essential to prevent the infection from recurring.

Alternatives for Dyspepsia

For dyspepsia, antacids or PPIs may help relieve symptoms. Eating smaller, more frequent meals and avoiding trigger foods can also reduce discomfort associated with dyspepsia.

Recent Updates on Bismuth Subsalicylate Research

Recent studies have explored the potential of Bismuth subsalicylate in treating conditions beyond its traditional uses. For example, research is ongoing to evaluate its role in managing certain bacterial infections due to its antimicrobial properties. Additionally, studies are investigating its potential to reduce inflammation in the gastrointestinal tract, which could make it a useful adjunct therapy for inflammatory bowel diseases (IBD). However, more research is needed to confirm these benefits. As always, consult your healthcare provider before considering any new treatments. You can also schedule a telemedicine appointment with one of our providers for the latest information and guidance on your treatment options.

James Kingsley

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