What is it?

Bismuth subsalicylate is used to treat upset stomach, diarrhea, heartburn, indigestion, and nausea. It may also be used to prevent traveler's diarrhea and to treat stomach ulcer and upset stomach related to an infection with Helicobacter pylori (a bacteria).

Other names for bismuth subsalicylate include: Pepto Bismol, Kaopectate.

Ask your doctor, nurse, or pharmacist if you need more information about this medicine or if any information in this leaflet concerns you.

Before Using:

Tell your doctor if you

• are taking medicine or are allergic to aspirin or any other medicine (prescription or over-the-counter (OTC) or dietary supplement) (21).
• are pregnant or plan to become pregnant while using this medicine.
• are breastfeeding.
• have diabetes, bleeding ulcers, gout, or a bleeding disorder (21).
• have any other health problems, such as high blood pressure or heart or blood vessel disease.

Dosage:

Talk with your caregiver about how much bismuth subsalicylate you should take. The amount depends on the strength of the medicine and the reason you are taking bismuth subsalicylate. If you are using this medicine without instructions from your caregiver, follow the directions on the medicine bottle. Do not take more medicine or take it more often than the directions tell you to.

To store this medicine:

Keep all medicine locked up and away from children. Store medicine away from heat and direct light. Do not store your medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down and not work the way it should work. Throw away medicine that is out of date or that you do not need. Never share your medicine with others.

Drug and Food Interactions:

Do not take bismuth subsalicylate without talking to your doctor first if you are taking:

• Diabetes medicine (insulin or oral medicine such as glipizide, glyburide, metformin, Actos(R), Avandamet(R), Avandia(R), Januvia(R), Glucophage(R), Glucovance(R)) (21)
• Gout medicine (example: probenecid, sulfinpyrazone) (12)
• Methotrexate (Rheumatrex(R), Trexall(R)) (11)
• Pain or arthritis medicine (such as diclofenac, etodolac, indomethacin, Celebrex(R), Daypro(R), Dolobid(R), Feldene(R), Indocin(R), Relafen(R), Voltaren(R)) (21)
• Tetracycline antibiotics (examples: tetracycline, doxycycline, demeclocycline, methacycline, minocycline) (9)
• Warfarin (Coumadin(R)) (21)

Warnings:

• Before taking bismuth subsalicylate, tell your doctor if you are pregnant or breastfeeding.
• The maximum daily dose is 4.2 grams (2).
• Do not use in a child or teenager who has a cold, the flu, chicken pox, or any other virus. Do not give this medicine to a child or teenager who is recovering from any of these illness. If a child has behavior changes along with nausea and vomiting while using this medicine, call the child's doctor right away (16,21).
• Do not use if you have any allergies or sensitivity to salicylates or aspirin (16).
• Do not use if you have diabetes, gout, or a bleeding disorder (20,21).
• Your tongue or stool may turn a dark color when you use this medicine. This is normal and should go away soon after you stop using this medicine (21).
• Check with your doctor before using this medicine if you have a fever or blood in your stool (21).
• If your symptoms do not improve or if they get worse, call your doctor. If you still have diarrhea after you have been using this medicine for 2 days, stop using this medicine and call your doctor (21).

Side Effects:

Call your doctor right away if you have any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hand, swelling or tingling in your mouth or throat, chest tightness, trouble breathing, or rash
• Rectal bleeding, or blood or mucus in your stools (21)

Other Side Effects:

You may have the following side effects, but this medicine may also cause other side effects. Tell your doctor if you have side effects that you think are caused by this medicine.

• Ringing in the ears or changes in your hearing (2,4,17,18,21)
• Upset stomach, throwing up, and constipation (4,8,19,20)

References:

1. Product Information: Bismuth subsalicylate, Pepto-Bismol(R) Original Liquid and tablets. Procter & Gambel, Cincinnati, OH; 1992.

2. AMA Department of Drugs: Drug Evaluations Subscription. American Medical Association, Chicago, IL; 1991.

3. Steffen R: Wourdwide efficacy of bismuth subsalicylate in the treatment of traveler's diarrhea. Rev Infec Dis 1990; 12(suppl 1): S80-86.

4. Johnson PC, Ericsson CD, SuPont HL et al: Comparison of loperamide with bismuth subsalicylate for the treatment of acute traveler's diarrhea. JAMA 1986; 255:757-760.

5. McNulty CAM: Bismuth subsalicylate in the treatment of gastritis due to Campylobacter pylori. Rev Infect Dis 1990; 12 (supl 1):S94-S98.

6. Walsh JH & Peterson WL: The treatment of Helicobacter pylori infection in the management of peptic ulcer disease. N Engl J Med 1995; 333:984-991.

7. Soll AH: Medical treatment of peptic ulcer disease - practice guidelines. JAMA 1996; 275:622-629.

8. Eberhardt R & Kasper G: Effect of oral bismuth subsalicylate on Campylobacter pylori and on healing and relapse rate of peptic ulcer. Rev Infec Dis 1990; 12 (suppl 1) S115-119.

9. Ericsson CD, Feldman S, Pickering LK et al: Influence of subsalicylate bismuth on absorption of doxycycline. JAMA 1982; 247:2266-2267.

10. Albert KS, Welch RD, DeSante KA et al: Decreased tetracycline bioavailability caused by a bismuth subsalicylate antidiarrheal mixture. J Pharm Sci 1979;68:586-588.

11. Furst DE: Clinically important interactions of nonsteroidal antiinflammatory drugs with other medications. J Rheumatol Suppl 1988; 17:58-62.

12. Schachter D & Manis JG: Salicylate and salicyl conjugates: fluormetric estimation biosynthesis and renal excretion in man. J Clin Invest 1958;37:800.

13. Kersley GD et al: Value of uricosuric agents and in particular of G. 28 315 in gout. Ann Rheum Dis 1958; 17:326.

14. Yu TF, Dayton PG & Gutman AB: Mutual suppression of the uricosuric effects of sulfinpyrazone and salicylate: a study in interaction between drugs. J Clin Invest 1963; 42:1330.

15. Seegmiller JE & Grayzel AI: Use of newer uricosuric agents in the management of gout. JAMA 1960;173:1076.

16. Dole EJ: Bismuth subsalicylate monograph. In: Micromedex(R) Healthcare Series Vol 102. Micromedex Inc, Englewood, CO; 1999.

17. DuPont HL: Bismuth subsalicylate in the treatment and prevention of diarrheal disease. Drug Intell Clin Pharm 1987;21:687-693.

18. DuPont HL, Ericsson CD, Johnson PC Et al: Use of bismuth subsalicylate for the prevention of traveler's diarrhea. Rev Infect Dis 1990; 12(supp 1):S64-S67.

19. Steffen R, DuPont HL, Heusser R et al: Prevention of traveler's diarrhea by the tablet form of bismuth subsalicylate. Antimicrob Agents Chemother 1986;29:625-627.

20. Product Information: Helidac(R), bismuth subsalicylate, metronidazole, and tetracycline hydrochloride. Procter & Gamble, Cincinnati, OH; 1999.

21. Product Information: Pepto-Bismol(R), bismuth subsalicylate. Procter & Gamble, Cincinnati, OH, 2004.