Bismuth Subsalicylate

Trade Names:
Bismatrol
- Tablets, chewable 262 mg

Trade Names:
Bismatrol Extra Strength
- Liquid 524 mg/15 mL

Trade Names:
Pepto-Bismol Maximum Strength
- Liquid 524 mg/15 mL

Trade Names:
Pepto-Bismol
- Liquid 262 mg/15 mL
- Tablets, chewable 262 mg
- Caplets 262 mg

Trade Names:
Pink Bismuth
- Liquid 130 mg/15 mL
- Liquid 262 mg/ 15 mL

Pharmacology

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Produces antisecretory and antimicrobial effects; may have anti-inflammatory effect.

Pharmacokinetics

Absorption

In the GI tract, bismuth subsalicylate undergoes chemical dissociation to yield bismuth and salicylate. Bismuth absorption is negligible, and plasma levels of the salicylate are similar to levels achieved after a comparable dose of aspirin.

Metabolism

Chemical dissociation in the GI tract.

Elimination

Greater than 90% of salicylate is recovered in urine.

Indications and Usage

Treatment of indigestion without causing constipation, nausea, abdominal cramps; control of diarrhea, including traveler's diarrhea.

Unlabeled Uses

Treatment of recurrent ulcers, chronic infantile diarrhea, gastroenteritis associated with Norwalk virus; prevention of traveler's diarrhea.

Contraindications

Viral illness such as chickenpox or influenza in patients younger than 18 yr of age.

Dosage and Administration

PO 2 tablets (262 mg each) or 30 mL suspension every 30 to 60 min as needed (max, 8 doses/day).

PO 1 tablet or 15 mL suspension every 30 to 60 min as needed (max, 8 doses/day).

PO 2/ 3  tablet or 10 mL suspension every 30 to 60 min as needed (max, 8 doses/day).

PO 1/ 3 tablet or 5 mL suspension every 30 to 60 min as needed (max, 8 doses/day).

Consult health care provider.

Storage/Stability

Store at room temperature. Protect from light.

Drug Interactions

May cause salicylate toxicity.

May decrease effectiveness.

Drug may increase glucose-lowering effect of insulin.

Drug may increase effects and toxicity of methotrexate.

Drug may interfere with diuretic effect.

Drug may interfere with uricosuric effect.

Bismuth subsalicylate may reduce GI absorption of tetracyclines and diminish their effectiveness.

Drug may increase free fraction of valproic acid, leading to toxicity.

Laboratory Test Interactions

Bismuth subsalicylate is radiopaque and may interfere with radiologic examination of GI tract.

Adverse Reactions

EENT

Tinnitus; discoloration of tongue.

GI

Discoloration of stools; impaction.

Precautions

Pregnancy

Category C .

Lactation

Excreted in breast milk.

Children

May cause impaction.

Debilitated patients

May cause impaction.

Overdosage

Symptoms

Ringing in ears, respiratory alkalosis, nausea, vomiting, hypokalemia, neurologic abnormalities (eg, disorientation, seizures), dehydration, hyperthermia, unusual bleeding or bruising.

Patient Information

• Counsel patient to maintain adequate fluid intake (2 to 3 L/day) to prevent dehydration.
• Instruct patient to notify health care provider if diarrhea is accompanied by high fever or continues for longer than 2 days or if abdominal pain occurs.
• Advise patient not to use medication if concurrent viral illness is present.
• Instruct patient to consult health care provider before taking drug if concurrently taking other salicylates, anticoagulants or medications for diabetes or gout.
• Instruct patient to inform health care provider regarding bismuth subsalicylate administration before any scheduled radiologic studies or stool examinations.
• Inform patient of possibility of salicylate toxicity and associated symptoms, and instruct patient to notify health care provider if these symptoms occur.
• Explain that stools may become black or gray and tongue may darken.

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