Pepto-Bismol
Generic Name
Bismuth Subsalicylate
Manufacturer
Various (e.g., Procter & Gamble for Pepto-Bismol)
Country
Global (originated in USA)
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Description
Overview of the medicine
Bismuth Subsalicylate is an over-the-counter medication used to treat temporary discomforts of the stomach and gastrointestinal tract, such as diarrhea, indigestion, heartburn, and nausea.
Uses & Indications
Dosage
Adults
30 mL or 2 chewable tablets (525 mg total) every 30-60 minutes as needed. Do not exceed 8 doses (240 mL or 16 tablets) in 24 hours.
Elderly
Use with caution; similar to adults, monitor for salicylate toxicity, especially in those with renal impairment.
Renal_impairment
Avoid or use with extreme caution due to salicylate accumulation risk and potential for bismuth toxicity.
How to Take
For liquid: Shake well before use, use dosing cup. For chewable tablets: Chew thoroughly before swallowing. Can be taken with or without food.
Mechanism of Action
It works by a combination of actions: it has antacid properties, reduces inflammation, acts as a mild antimicrobial, and adsorbs toxins in the gut, reducing fluid and electrolyte loss. The salicylate component provides anti-inflammatory effects.
Pharmacokinetics
Onset
Symptoms relief typically within 30-60 minutes.
Excretion
Bismuth: Primarily via feces. Salicylate: Primarily via urine (renal).
Half life
Bismuth: Very long (weeks due to enterohepatic recirculation). Salicylate: 2-4 hours (dose-dependent).
Absorption
Bismuth is minimally absorbed from the GI tract. Salicylate is readily and extensively absorbed.
Metabolism
Bismuth is largely excreted unchanged or as bismuth compounds. Salicylate is metabolized in the liver to various metabolites.
Side Effects
Contraindications
- Allergy to salicylates (e.g., aspirin), history of gastrointestinal bleeding or ulcers, concomitant use of other salicylates.
- Children/teenagers recovering from flu or chickenpox (due to Reye's syndrome risk).
Drug Interactions
Methotrexate
Salicylate may decrease methotrexate excretion, potentially increasing its toxicity.
Probenecid and Sulfinpyrazone
Salicylate may reduce the uricosuric effects of these medications.
Warfarin and other Anticoagulants
May increase the risk of bleeding due to salicylate's antiplatelet effects.
Tetracycline and Quinolone Antibiotics
Bismuth can bind to these antibiotics, reducing their absorption and effectiveness. Administer at least 2 hours apart.
Storage
Store at room temperature (20-25°C or 68-77°F). Protect from freezing. Keep out of reach of children.
Overdose
Overdose primarily involves managing salicylate toxicity (tinnitus, dizziness, confusion, vomiting, hyperventilation, metabolic acidosis). Bismuth toxicity is rare but can occur with very high chronic doses (neurological symptoms). Management includes gastric lavage, activated charcoal, supportive care, IV fluids, bicarbonate for acidosis, and dialysis in severe salicylate poisoning.
Pregnancy & Lactation
Pregnancy: Avoid in the third trimester due to salicylate effects on fetal circulation (premature closure of ductus arteriosus). Lactation: Use with caution during lactation; small amounts of salicylate may pass into breast milk.
Side Effects
Contraindications
- Allergy to salicylates (e.g., aspirin), history of gastrointestinal bleeding or ulcers, concomitant use of other salicylates.
- Children/teenagers recovering from flu or chickenpox (due to Reye's syndrome risk).
Drug Interactions
Methotrexate
Salicylate may decrease methotrexate excretion, potentially increasing its toxicity.
Probenecid and Sulfinpyrazone
Salicylate may reduce the uricosuric effects of these medications.
Warfarin and other Anticoagulants
May increase the risk of bleeding due to salicylate's antiplatelet effects.
Tetracycline and Quinolone Antibiotics
Bismuth can bind to these antibiotics, reducing their absorption and effectiveness. Administer at least 2 hours apart.
Storage
Store at room temperature (20-25°C or 68-77°F). Protect from freezing. Keep out of reach of children.
Overdose
Overdose primarily involves managing salicylate toxicity (tinnitus, dizziness, confusion, vomiting, hyperventilation, metabolic acidosis). Bismuth toxicity is rare but can occur with very high chronic doses (neurological symptoms). Management includes gastric lavage, activated charcoal, supportive care, IV fluids, bicarbonate for acidosis, and dialysis in severe salicylate poisoning.
Pregnancy & Lactation
Pregnancy: Avoid in the third trimester due to salicylate effects on fetal circulation (premature closure of ductus arteriosus). Lactation: Use with caution during lactation; small amounts of salicylate may pass into breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from manufacturing date, check packaging for specific expiry.
Availability
Pharmacies, Supermarkets
Approval Status
Over-the-Counter (OTC), Widely Approved
Patent Status
Expired
Clinical Trials
Numerous clinical trials have established the efficacy of bismuth subsalicylate for treating various gastrointestinal symptoms, particularly traveler's diarrhea. Studies also support its role in symptomatic relief of indigestion and upset stomach.
Lab Monitoring
- Not typically required for short-term OTC use.
- In cases of suspected salicylate toxicity, monitoring of blood salicylate levels and acid-base balance.
Doctor Notes
- Emphasize the contraindication for children/teenagers with viral infections due to Reye's syndrome risk.
- Counsel patients about the harmless temporary darkening of tongue and stools.
- Advise against use with aspirin allergy or concurrent anticoagulant therapy without prior medical consultation.
- Recommend limited duration of use (max 2 days for diarrhea) and seeking medical advice for persistent symptoms.
Patient Guidelines
- Do not use for more than 2 days for diarrhea without consulting a doctor.
- Do not give to children or teenagers with flu or chickenpox due to the risk of Reye's syndrome.
- If symptoms worsen or persist, or if you experience ringing in your ears, seek medical attention.
- Avoid if allergic to aspirin or other salicylates.
Missed Dose Advice
This is an as-needed medication. Take the next dose when symptoms occur. Do not double dose.
Driving Precautions
No known effects on ability to drive or operate machinery. If you experience dizziness or confusion (rare), avoid driving.
Lifestyle Advice
- Stay well-hydrated, especially during diarrhea, to prevent dehydration.
- Avoid irritating foods and drinks if experiencing indigestion or heartburn.
- Maintain a balanced diet and regular meal schedule.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.