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Pepto-Bismol Disease Interactions

There are 2 disease interactions with Pepto-Bismol (bismuth subsalicylate).


Salicylates (applies to Pepto-Bismol) Reye's syndrome

Major Potential Hazard, High plausibility. Applicable conditions: Influenza, Varicella-Zoster

The use of salicylates, primarily aspirin, in children with varicella infections or influenza-like illnesses has been associated with an increased risk of Reye's syndrome. Although a causal relationship has not been established, the majority of evidence to date seems to support the association. Most authorities, including the American Academy of Pediatrics Committee on Infectious Diseases, recommend avoiding the use of salicylates in children and teenagers with known or suspected varicella or influenza and during presumed outbreaks of influenza. If antipyretic or analgesic therapy is indicated under these circumstances, acetaminophen may be an appropriate alternative. The same precautions should also be observed with related agents such as salicylamide or diflunisal because of their structural and pharmacological similarities to salicylate.


  1. Epidemiology Office, Divisiion of Viral and Rickettsial Diseasses, Center for Infectious Diseases, Centers for Disease Control. (1989) "Leads from the MMWR. Reye syndrome surveillance--United States, 1987 and 1988." JAMA, 261, 3520,
  2. Hasking GJ, Duggan JM (1982) "Encephalopathy from bismuth subsalicylate." Med J Aust, 2, p. 167
  3. (2001) "Product Information. Pepto-Bismol (bismuth subsalicylate)." Procter and Gamble Pharmaceuticals
  4. (2001) "Product Information. Salflex (salsalate)." Carnrick Laboratories Inc
  5. (2001) "Product Information. Ecotrin (aspirin)." SmithKline Beecham
  6. Arvin A, Kliegman R, Nelson W, Behrman R, eds. (1996) "Nelson Textbook of Pediatrics." Philadelphia, PA: W.B. Saunders Company
  7. American Academy of Pediatrics. Committee on Infectious Diseases; Peter G, ed. (1997) "Red BooK: Report of the Committee on Infectious Diseases." Grove Village, IL: American Academy of Pediatrics
  8. Belay ED, Bresee JS, Holman RC, Khan AS, Shahriari A, Schonberger LB (1999) "Reye's syndrome in the United States from 1981 through 1997." N Engl J Med, 340, p. 1377-82
  9. (2001) "Product Information. Rexolate (sodium thiosalicylate)." Hyrex Pharmaceuticals
View all 9 references

Salicylates (applies to Pepto-Bismol) coagulation

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Bleeding, Coagulation Defect, Thrombocytopathy, Thrombocytopenia, Vitamin K Deficiency

All salicylates can interfere with the action of vitamin K and induce a dose-dependent alteration in hepatic synthesis of coagulation factors VII, IX and X. At usual recommended dosages, a slight increase in prothrombin time (PT) may occur. Therapy with salicylates, especially if given in high dosages, should be administered cautiously in patients with significant active bleeding or a hemorrhagic diathesis, including hemostatic and/or coagulation defects associated with hemophilia, vitamin K deficiency, hypoprothombinemia, thrombocytopenia, thrombocytopathy, or severe hepatic impairment. The same precaution should also be observed with the use of related agents such as salicylamide because of their structural and pharmacological similarities to salicylate.


  1. Barrow MV, Quick DT, Cunningham RW (1967) "Salicylate hypoprothrombinemia in rheumatoid arthritis with liver disease. Report of two cases." Arch Intern Med, 120, p. 620-4
  2. Fausa O (1970) "Salicylate-induced hypoprothrombinemia: a report of four cases." Acta Med Scand, 188, p. 403-8
  3. American Medical Association, Division of Drugs and Toxicology (1994) "Drug evaluations annual 1994." Chicago, IL: American Medical Association;
  4. (2001) "Product Information. Pepto-Bismol (bismuth subsalicylate)." Procter and Gamble Pharmaceuticals
  5. (2001) "Product Information. Salflex (salsalate)." Carnrick Laboratories Inc
View all 5 references

Pepto-Bismol drug interactions

There are 133 drug interactions with Pepto-Bismol (bismuth subsalicylate).

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.